MEDICARE: MS. WANDA M BRYK-MCHUGH O.T.R.

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	5201000981	MI

General Provider Information

NPI Number	:	1861510299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WANDA M BRYK-MCHUGH O.T.R.

Provider Business Mailing Address
First Line	:	3902 MCKINLEY ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2505
Country	:	US
Telephone Number	:	313-530-0382
Fax Number	:

Provider Business Practice Location Address
First Line	:	3902 MCKINLEY ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2505
Country	:	US
Telephone Number	:	313-530-0382
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	01/30/2012

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