MEDICARE: MR. THOMAS JAMES ISKRA OTR

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	5201006179	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5201006179	OTHER	MI	MICHIGAN

General Provider Information

NPI Number	:	1710292966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS JAMES ISKRA OTR

Provider Business Mailing Address
First Line	:	9647 BARTEL RD
Second Line	:
City	:	COLUMBUS
State	:	MI
Zip	:	48063-4109
Country	:	US
Telephone Number	:	586-727-4975
Fax Number	:

Provider Business Practice Location Address
First Line	:	9647 BARTEL RD
Second Line	:
City	:	COLUMBUS
State	:	MI
Zip	:	48063-4109
Country	:	US
Telephone Number	:	586-727-4975
Fax Number	:

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

Provider Enumeration Date	:	08/12/2010
Last Update Date	:	08/12/2010

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