MEDICARE: BEATRICE MAE BARTRAM MSW

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	1041C0700X	Clinical Social Worker	I.0005071	OH

General Provider Information

NPI Number	:	1023024890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATRICE MAE BARTRAM MSW

Provider Business Mailing Address
First Line	:	1203 HINER RD
Second Line	:
City	:	ORIENT
State	:	OH
Zip	:	43146-9442
Country	:	US
Telephone Number	:	614-871-4526
Fax Number	:

Provider Business Practice Location Address
First Line	:	1955 OHIO DR
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-4835
Country	:	US
Telephone Number	:	614-257-5816
Fax Number	:	614-257-5801

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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