MEDICARE: RACHEL EDGERLY MT-BC

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

General Provider Information

NPI Number	:	1285171181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL EDGERLY MT-BC

Provider Business Mailing Address
First Line	:	34 SAPPHIRE LN
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-2642
Country	:	US
Telephone Number	:	240-422-4184
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 SAPPHIRE LN
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-2642
Country	:	US
Telephone Number	:	240-422-4184
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	01/30/2017

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