MEDICARE: MR. THOMAS M GOLDBACHER 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	225XH1200X	Hand Occupational Therapist	46TR00279700	NJ

General Provider Information

NPI Number	:	1881699841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS M GOLDBACHER OTR-L

Provider Business Mailing Address
First Line	:	132 GROVE ST
Second Line	:
City	:	HADDONFIELD
State	:	NJ
Zip	:	08033-1224
Country	:	US
Telephone Number	:	856-795-9330
Fax Number	:	856-854-7935

Provider Business Practice Location Address
First Line	:	132 GROVE ST
Second Line	:
City	:	HADDONFIELD
State	:	NJ
Zip	:	08033-1224
Country	:	US
Telephone Number	:	856-795-9330
Fax Number	:	856-854-7935

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/08/2010

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