Basic Information
| Provider Information | |||||||||
| NPI: | 1003297367 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | MEG | ||||||||
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| Credential: | MT-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 SELWYN AVE | ||||||||
| Address2: | QUEENS UNIVERSITY OF CHARLOTTE | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282740001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043372520 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 SELWYN AVE | ||||||||
| Address2: | QUEENS UNIVERSITY OF CHARLOTTE | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282740001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043372520 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2015 | ||||||||
| LastUpdateDate: | 06/12/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225A00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Music Therapist |
No ID Information.