MEDICARE: KATELYN COLLEEN LOPEZ 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	:	1902470628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN COLLEEN LOPEZ MT-BC

Provider Business Mailing Address
First Line	:	6603 AUGUSTA PINES PKWY E
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77389-4054
Country	:	US
Telephone Number	:	801-201-9263
Fax Number	:

Provider Business Practice Location Address
First Line	:	6603 AUGUSTA PINES PKWY E
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77389-4054
Country	:	US
Telephone Number	:	801-201-9263
Fax Number	:

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

Provider Enumeration Date	:	05/17/2021
Last Update Date	:	05/17/2021

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