MEDICARE: OLIVIA ROSE WATKINS 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
2	225A00000X	Music Therapist		IL

General Provider Information

NPI Number	:	1366181224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA ROSE WATKINS MT-BC

Provider Business Mailing Address
First Line	:	446 FERNDALE CT
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-6731
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	446 FERNDALE CT
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-6731
Country	:	US
Telephone Number	:	847-254-7209
Fax Number	:

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

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	05/31/2022

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