MEDICARE: CARLY FLAAGAN 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	12204

General Provider Information

NPI Number	:	1679080741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY FLAAGAN MT-BC

Provider Business Mailing Address
First Line	:	113 W MYRTLE ST APT 7
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3052
Country	:	US
Telephone Number	:	701-215-2190
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 REMINGTON ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4142
Country	:	US
Telephone Number	:	701-215-2190
Fax Number	:

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

Provider Enumeration Date	:	01/10/2018
Last Update Date	:	01/10/2018

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Directions to “ CARLY FLAAGAN MT-BC” Practice Location

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