MEDICARE: AMY S KLEINSMITH 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	10811	CT

General Provider Information

NPI Number	:	1427482561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY S KLEINSMITH MT-BC

Provider Business Mailing Address
First Line	:	164 VERNON AVE
Second Line	:	#24
City	:	VERNON
State	:	CT
Zip	:	06066-4329
Country	:	US
Telephone Number	:	484-336-7363
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 WINDSOR AVE
Second Line	:	SECOND FLOOR
City	:	MERIDEN
State	:	CT
Zip	:	06451-2900
Country	:	US
Telephone Number	:	860-518-5557
Fax Number	:

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

Provider Enumeration Date	:	08/26/2013
Last Update Date	:	08/26/2013

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