MEDICARE: BARRY RABORN OP

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	225000000X	Orthotic Fitter	10065	TX

General Provider Information

NPI Number	:	1851377626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY RABORN OP

Provider Business Mailing Address
First Line	:	7401 S. MAIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4509
Country	:	US
Telephone Number	:	713-799-2300
Fax Number	:	713-794-3380

Provider Business Practice Location Address
First Line	:	2525 W BELLFORT ST
Second Line	:	SUITE 150
City	:	HOUSTON
State	:	TX
Zip	:	77054-5000
Country	:	US
Telephone Number	:	713-349-9335
Fax Number	:	713-349-8433

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	12/09/2008

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