MEDICARE: JENNIFER RUSSELL PHILLIPS MT-BC, NMT

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	225A00000X

General Provider Information

NPI Number	:	1740887074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RUSSELL PHILLIPS MT-BC, NMT

Provider Business Mailing Address
First Line	:	60 WOODY LN
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14625-1316
Country	:	US
Telephone Number	:	585-402-0773
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 N PLYMOUTH AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14614-1221
Country	:	US
Telephone Number	:	585-454-4596
Fax Number	:

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

Provider Enumeration Date	:	10/09/2020
Last Update Date	:	10/09/2020

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