MEDICARE: MRS. DIANE MEYER BAUMAN 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	07897	MI

General Provider Information

NPI Number	:	1982914735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANE MEYER BAUMAN MT-BC

Provider Business Mailing Address
First Line	:	11650 DOWNES ST NE
Second Line	:
City	:	LOWELL
State	:	MI
Zip	:	49331-9489
Country	:	US
Telephone Number	:	616-897-7842
Fax Number	:	616-897-7054

Provider Business Practice Location Address
First Line	:	11650 DOWNES ST NE
Second Line	:
City	:	LOWELL
State	:	MI
Zip	:	49331-9489
Country	:	US
Telephone Number	:	616-897-7842
Fax Number	:	616-897-7054

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

Provider Enumeration Date	:	10/14/2010
Last Update Date	:	10/14/2010

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