MEDICARE: MRS. MICHELLE BARTLEY

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	ISW1478	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ISW1478	OTHER	FL	CLINICAL SOCIAL WORKER

General Provider Information

NPI Number	:	1073091609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE BARTLEY

Provider Business Mailing Address
First Line	:	1280 S POWERLINE RD STE 25
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-4342
Country	:	US
Telephone Number	:	954-947-3607
Fax Number	:

Provider Business Practice Location Address
First Line	:	1280 S POWERLINE RD STE 25
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-4342
Country	:	US
Telephone Number	:	954-947-3607
Fax Number	:

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

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	08/06/2018

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