Provider Demographics
NPI:1053843011
Name:BURNS, MICHELE MONICA (MT-BC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MONICA
Last Name:BURNS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 BRENT RD
Mailing Address - Street 2:
Mailing Address - City:ORELAND
Mailing Address - State:PA
Mailing Address - Zip Code:19075-2201
Mailing Address - Country:US
Mailing Address - Phone:215-692-2334
Mailing Address - Fax:
Practice Address - Street 1:2050 W CHESTER PIKE STE 115
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2742
Practice Address - Country:US
Practice Address - Phone:610-449-9669
Practice Address - Fax:610-449-5566
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA12435225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032939740002Medicaid
PA1032939740001Medicaid