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NPI Code Detail

MEDICARE: MARY LYNN BAIN

MEDICARE: MARY LYNN BAIN
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
1225X00000XOccupational Therapist1365AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15U270OTHERARBCBS

General Provider Information

NPI Number : 1588625016
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY LYNN BAIN
Provider Business Mailing Address
First Line : 701 E GEORGE AVE
Second Line :
City : POCOLA
State : OK
Zip : 74902-2304
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3304 S M ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-2903
Country : US
Telephone Number : 479-785-4677
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2006
Last Update Date : 07/08/2007

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1548220379 — MRS. MARTHA OSBUN P.T.
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1649231499 — KRISTIN PERDUE
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1770544520 — BILLIE SUDIGALA
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Directions to “ MARY LYNN BAIN ” Practice Location

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