Provider Demographics
NPI:1457993594
Name:BRUNS, DEEETTE C (MT)
Entity Type:Individual
Prefix:
First Name:DEEETTE
Middle Name:C
Last Name:BRUNS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4662
Mailing Address - Country:US
Mailing Address - Phone:207-299-2146
Mailing Address - Fax:
Practice Address - Street 1:92 JAMES ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4662
Practice Address - Country:US
Practice Address - Phone:207-299-2146
Practice Address - Fax:207-942-8729
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT1210225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist