Provider Demographics
NPI:1679203780
Name:VIERYA, MIKAILA (LPMT, MT-BC)
Entity Type:Individual
Prefix:
First Name:MIKAILA
Middle Name:
Last Name:VIERYA
Suffix:
Gender:F
Credentials:LPMT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 FOREST HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1755
Mailing Address - Country:US
Mailing Address - Phone:540-454-3193
Mailing Address - Fax:
Practice Address - Street 1:2568A RIVA RD STE 103
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7445
Practice Address - Country:US
Practice Address - Phone:410-697-1812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist