MEDICARE: TARA RAE MT-BC, NMT

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	14004	PA

General Provider Information

NPI Number	:	1336826254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA RAE MT-BC, NMT

Provider Business Mailing Address
First Line	:	1406 FIRTH ST APT 2
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-3704
Country	:	US
Telephone Number	:	724-831-6913
Fax Number	:

Provider Business Practice Location Address
First Line	:	1406 FIRTH ST APT 2
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-3704
Country	:	US
Telephone Number	:	724-831-6913
Fax Number	:

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

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	07/10/2023

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