MEDICARE: MISS PAULA'S MUSIC THERAPY SERVICES LLC

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	09748	TX

General Provider Information

NPI Number	:	1962766188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISS PAULA'S MUSIC THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	5439 GLEN LAKES DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5439 GLEN LAKES DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4307
Country	:	US
Telephone Number	:	816-813-1128
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	PAULA GREGORY
Credential	:	MT-BC
Telephone Number	:	816-813-1128

Provider Enumeration Date	:	07/03/2012
Last Update Date	:	07/03/2012

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