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NPI Code Detail

MEDICARE: MIA LYNN CELLINO LPMT, MT-BC

MEDICARE: MIA LYNN CELLINO LPMT, 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
1225A00000XMusic TherapistMUT000209GA

General Provider Information

NPI Number : 1881158533
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIA LYNN CELLINO LPMT, MT-BC
Provider Business Mailing Address
First Line : 215 FERNWOOD PL
Second Line :
City : WOODSTOCK
State : GA
Zip : 30188-6242
Country : US
Telephone Number : 404-402-6190
Fax Number :
Provider Business Practice Location Address
First Line : 9880 HICKORY FLAT HWY
Second Line :
City : WOODSTOCK
State : GA
Zip : 30188-3081
Country : US
Telephone Number : 770-687-2542
Fax Number : 770-783-5049
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2019
Last Update Date : 01/28/2019

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