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NPI Code Detail

MEDICARE: MS. SAMANTHA GRAHAM MT-BC

MEDICARE:  MS. SAMANTHA  GRAHAM  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
1225A00000XMusic Therapist13621TX

General Provider Information

NPI Number : 1528556826
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SAMANTHA GRAHAM MT-BC
Provider Business Mailing Address
First Line : 3320 RIVEROAD CT APT 814
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-1174
Country : US
Telephone Number : 281-309-2410
Fax Number :
Provider Business Practice Location Address
First Line : 3320 RIVEROAD CT APT 814
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-1174
Country : US
Telephone Number : 281-309-2410
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2018
Last Update Date : 04/23/2018

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Directions to “ MS. SAMANTHA GRAHAM MT-BC” Practice Location

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