MEDICARE: ASHLEY A ROSALES MTBC

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	MT-T-10206912	OR

General Provider Information

NPI Number	:	1689333015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY A ROSALES MTBC

Provider Business Mailing Address
First Line	:	4108 SW SPRATT WAY APT 55
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97078-2485
Country	:	US
Telephone Number	:	951-813-6970
Fax Number	:

Provider Business Practice Location Address
First Line	:	11830 KERR PKWY
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-1249
Country	:	US
Telephone Number	:	951-813-6970
Fax Number	:

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

Provider Enumeration Date	:	12/13/2021
Last Update Date	:	12/13/2021

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