MEDICARE: RESONATE MUSIC THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225A00000X	Music Therapist	12894	CO

General Provider Information

NPI Number	:	1245727742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESONATE MUSIC THERAPY LLC

Provider Business Mailing Address
First Line	:	4670 WINEWOOD VILLAGE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-1221
Country	:	US
Telephone Number	:	719-492-5282
Fax Number	:

Provider Business Practice Location Address
First Line	:	4670 WINEWOOD VILLAGE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-1221
Country	:	US
Telephone Number	:	719-492-5282
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MUSIC THERAPIST
Name	:	MARISSA JAE FERL
Credential	:	MT-BC
Telephone Number	:	719-492-5282

Provider Enumeration Date	:	04/19/2018
Last Update Date	:	04/19/2018

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Directions to “RESONATE MUSIC THERAPY LLC ” Practice Location

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