MEDICARE: MRS. JODY LOUISE KERSHNER 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	:	1366797656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JODY LOUISE KERSHNER MT-BC

Provider Business Mailing Address
First Line	:	2288 FOREST GREEN CT
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-2503
Country	:	US
Telephone Number	:	404-308-7057
Fax Number	:	770-977-7057

Provider Business Practice Location Address
First Line	:	2288 FOREST GREEN CT
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-2503
Country	:	US
Telephone Number	:	404-308-7057
Fax Number	:	770-977-7057

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

Provider Enumeration Date	:	07/23/2012
Last Update Date	:	07/23/2012

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