MEDICARE: SHANNON L BOWLES 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

General Provider Information

NPI Number	:	1740303197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON L BOWLES MT-BC

Provider Business Mailing Address
First Line	:	2427 WESTWOOD AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-1008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2427 WESTWOOD AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-1008
Country	:	US
Telephone Number	:	502-459-4828
Fax Number	:

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	08/21/2007

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