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NPI Code Detail

MEDICARE: PHILLIP BARTRAM

MEDICARE: PHILLIP BARTRAM
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
1224Z00000XOccupational Therapy AssistantC1553WV

General Provider Information

NPI Number : 1033278247
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILLIP BARTRAM
Provider Business Mailing Address
First Line : 1112 OAKRIDGE CT
Second Line :
City : RUSSELL
State : KY
Zip : 41169-1414
Country : US
Telephone Number : 606-833-8781
Fax Number :
Provider Business Practice Location Address
First Line : 6900 COUNTRY CLUB DR
Second Line :
City : HUNTINGTON
State : WV
Zip : 25705-2000
Country : US
Telephone Number : 304-733-1060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2006
Last Update Date : 07/08/2007

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Directions to “ PHILLIP BARTRAM ” Practice Location

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