Provider Demographics
NPI:1154084820
Name:BOCK, SUSAN VIRGINIA (MT-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:VIRGINIA
Last Name:BOCK
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 1:2106 LOOK ROCK CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-1794
Mailing Address - Country:US
Mailing Address - Phone:309-369-6459
Mailing Address - Fax:
Practice Address - Street 1:2106 LOOK ROCK CT
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-1794
Practice Address - Country:US
Practice Address - Phone:309-369-6459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty