MEDICARE: ASSISTIVE TECHNOLOGY PROFESSIONAL'S

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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1871091025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSISTIVE TECHNOLOGY PROFESSIONAL'S

Provider Business Mailing Address
First Line	:	5325 BEECH RD STE 23
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-1800
Country	:	US
Telephone Number	:	301-899-0800
Fax Number	:	301-899-0900

Provider Business Practice Location Address
First Line	:	5325 BEECH RD STE 23
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-1800
Country	:	US
Telephone Number	:	310-899-0800
Fax Number	:	301-899-0900

Authorized Official
Title or Position	:	RESIDENT AGENT
Name	:	CORTLAND BARD
Credential	:	ATP
Telephone Number	:	310-899-0800

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	01/23/2018

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