MEDICARE: MICHAEL HAMILTON BARRY

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	056011224	IL

General Provider Information

NPI Number	:	1407229438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL HAMILTON BARRY

Provider Business Mailing Address
First Line	:	1847 W OHIO ST APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-5506
Country	:	US
Telephone Number	:	773-454-8392
Fax Number	:

Provider Business Practice Location Address
First Line	:	1847 W OHIO ST APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-5506
Country	:	US
Telephone Number	:	773-454-8392
Fax Number	:

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

Provider Enumeration Date	:	11/13/2015
Last Update Date	:	11/13/2015

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