MEDICARE: BARBARA LYNETTE BERG

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	5201011243	MI

General Provider Information

NPI Number	:	1366115016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA LYNETTE BERG

Provider Business Mailing Address
First Line	:	408 N 5TH AVE
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9245
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	408 N 5TH AVE
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9245
Country	:	US
Telephone Number	:	989-362-2211
Fax Number	:

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

Provider Enumeration Date	:	07/28/2021
Last Update Date	:	07/28/2021

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Directions to “ BARBARA LYNETTE BERG ” Practice Location

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