MEDICARE: BARBARA JEAN PERRY OTRL

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	5201003575	MI

General Provider Information

NPI Number	:	1053815845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA JEAN PERRY OTRL

Provider Business Mailing Address
First Line	:	34643 KETSIN DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-5235
Country	:	US
Telephone Number	:	586-978-2280
Fax Number	:	586-978-8407

Provider Business Practice Location Address
First Line	:	34643 KETSIN DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-5235
Country	:	US
Telephone Number	:	586-978-2280
Fax Number	:	586-978-8407

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

Provider Enumeration Date	:	03/19/2018
Last Update Date	:	03/19/2018

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