MEDICARE: MS. CARRIE ANN BARTELME MS, OTR-L

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	225XP0200X	Pediatric Occupational Therapist	OT003448	GA
2	225X00000X	Occupational Therapist	OT003448	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	10036804	OTHER	GA	AMERIGROUP
3	7099600	OTHER	GA	AETNA

General Provider Information

NPI Number	:	1215990882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARRIE ANN BARTELME MS, OTR-L

Provider Business Mailing Address
First Line	:	4062 PEACHTREE RD NE STE A-123
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-3021
Country	:	US
Telephone Number	:	404-409-7099
Fax Number	:

Provider Business Practice Location Address
First Line	:	4062 PEACHTREE RD NE STE A-123
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-3021
Country	:	US
Telephone Number	:	404-409-7099
Fax Number	:

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	06/03/2016

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