Provider Demographics
NPI:1619205796
Name:PRINCE BARTSCHI, JAMIE (MMT, MT-BC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:PRINCE BARTSCHI
Suffix:
Gender:F
Credentials:MMT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4565 NOUNAN RD
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:ID
Mailing Address - Zip Code:83254-5006
Mailing Address - Country:US
Mailing Address - Phone:801-520-2626
Mailing Address - Fax:
Practice Address - Street 1:4565 NOUNAN RD
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:ID
Practice Address - Zip Code:83254-5006
Practice Address - Country:US
Practice Address - Phone:801-520-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT07917225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDG0176OtherMEDICARE HCPCS CODE FOR PHP