MEDICARE: MR. PHILIP ALAN BUSHEY M.A. SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP-0113	OH

General Provider Information

NPI Number	:	1477707131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILIP ALAN BUSHEY M.A. SLP

Provider Business Mailing Address
First Line	:	234 WOOD ST. NORTH
Second Line	:
City	:	EAST CANTON
State	:	OH
Zip	:	44730
Country	:	US
Telephone Number	:	330-488-0667
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 WOOD ST. NORTH
Second Line	:
City	:	EAST CANTON
State	:	OH
Zip	:	44730
Country	:	US
Telephone Number	:	330-488-0667
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2008
Last Update Date	:	11/07/2008

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