Basic Information
Provider Information
NPI: 1033557624
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NAKAMURA
FirstName: NORIKO
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MT-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 15208 W 123RD ST
Address2:  
City: OLATHE
State: KS
PostalCode: 660621081
CountryCode: US
TelephoneNumber: 9137441265
FaxNumber:  
Practice Location
Address1: 15208 W 123RD ST
Address2:  
City: OLATHE
State: KS
PostalCode: 660621081
CountryCode: US
TelephoneNumber: 9137441265
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/05/2013
LastUpdateDate: 06/21/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225A00000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist 

ID Information
IDTypeStateIssuerDescription
0706201 CERTIFICATION BOARD FOR MUSIC THERAPISTSOTHER


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