MEDICARE: KIRK WHARTON

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	225X00000X	Occupational Therapist	210896	LA

General Provider Information

NPI Number	:	1033341540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK WHARTON

Provider Business Mailing Address
First Line	:	3311 SHADOW HILL DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-3791
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 SHADOW HILL DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-3791
Country	:	US
Telephone Number	:	504-250-4172
Fax Number	:

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

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	08/17/2009

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Directions to “ KIRK WHARTON ” Practice Location

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