MEDICARE: CORINNE STYPULKOSKI 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	13366	NY

General Provider Information

NPI Number	:	1386312197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORINNE STYPULKOSKI MT-BC

Provider Business Mailing Address
First Line	:	14539 SUNDIAL PL
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34202-5895
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4430 PORTOFINO WAY APT 203
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-7894
Country	:	US
Telephone Number	:	561-290-2941
Fax Number	:

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

Provider Enumeration Date	:	09/06/2021
Last Update Date	:	09/06/2021

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