MEDICARE: KATHLEEN BAIR

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	5201002737	MI

General Provider Information

NPI Number	:	1922438845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN BAIR

Provider Business Mailing Address
First Line	:	783 LAKE GEORGE TRL
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696-9457
Country	:	US
Telephone Number	:	231-421-1690
Fax Number	:

Provider Business Practice Location Address
First Line	:	783 LAKE GEORGE TRL
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696-9457
Country	:	US
Telephone Number	:	231-421-1690
Fax Number	:

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

Provider Enumeration Date	:	11/13/2013
Last Update Date	:	11/13/2013

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Directions to “ KATHLEEN BAIR ” Practice Location

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