MEDICARE: ISAAC BARR 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	225X00000X	Occupational Therapist	4941	TN
2	225X00000X	Occupational Therapist	OT2912	MS

General Provider Information

NPI Number	:	1790182319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAAC BARR OTR/L

Provider Business Mailing Address
First Line	:	5052 VILLAGE WOODS DR
Second Line	:	APT 2
City	:	MEMPHIS
State	:	TN
Zip	:	38116-8662
Country	:	US
Telephone Number	:	901-859-4692
Fax Number	:

Provider Business Practice Location Address
First Line	:	5052 VILLAGE WOODS DR
Second Line	:	APT 2
City	:	MEMPHIS
State	:	TN
Zip	:	38116-8662
Country	:	US
Telephone Number	:	901-859-4692
Fax Number	:

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

Provider Enumeration Date	:	11/25/2014
Last Update Date	:	11/25/2014

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