Provider Demographics
NPI:1912720483
Name:AUSTIN, MIKAYLA MARIE (MT-BC)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:MARIE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:THEO
Other - Middle Name:
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MT-BC
Mailing Address - Street 1:3552 STEINWAY ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-1423
Mailing Address - Country:US
Mailing Address - Phone:919-672-8831
Mailing Address - Fax:
Practice Address - Street 1:3552 STEINWAY ST APT 3
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-1423
Practice Address - Country:US
Practice Address - Phone:919-672-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17393225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist