Healthcare Provider Details

I. General information

NPI: 1295711026
Provider Name (Legal Business Name): HAZEL M BARR OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LRMC ATTN: MCEUL-DCCS (CREDENTIALS.), CMR 402
APO AE
09180
DE

IV. Provider business mailing address

LRMC CMR 402 BOX 2109
APO AE
09180
DE

V. Phone/Fax

Practice location:
  • Phone: 011496371868839
  • Fax:
Mailing address:
  • Phone: 496-312-8553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number000024
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: