MEDICARE: CARLY RAE KAZMERZAK RAMTHUN MA, MT-BC, CTP

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	101Y00000X	Counselor	10150	IA
2	225A00000X	Music Therapist

General Provider Information

NPI Number	:	1598158230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY RAE KAZMERZAK RAMTHUN MA, MT-BC, CTP

Provider Business Mailing Address
First Line	:	3317 BRUGGER PL
Second Line	:
City	:	MC FARLAND
State	:	WI
Zip	:	53558-9553
Country	:	US
Telephone Number	:	515-577-0429
Fax Number	:

Provider Business Practice Location Address
First Line	:	3317 BRUGGER PL
Second Line	:
City	:	MC FARLAND
State	:	WI
Zip	:	53558-9553
Country	:	US
Telephone Number	:	515-577-0429
Fax Number	:

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

Provider Enumeration Date	:	03/05/2015
Last Update Date	:	09/26/2018

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