MEDICARE: KATHERINE VAN LOAN

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	:	1740897115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE VAN LOAN

Provider Business Mailing Address
First Line	:	555 KAPPOCK ST APT 2G
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-6425
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 KAPPOCK ST APT 2G
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-6425
Country	:	US
Telephone Number	:	516-242-2515
Fax Number	:

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

Provider Enumeration Date	:	09/29/2020
Last Update Date	:	09/29/2020

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Directions to “ KATHERINE VAN LOAN ” Practice Location

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