Provider Demographics
NPI:1902237332
Name:BARNUM, MARY (ATC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BARNUM
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9416
Mailing Address - Country:US
Mailing Address - Phone:413-231-4142
Mailing Address - Fax:413-748-3052
Practice Address - Street 1:33 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007-9416
Practice Address - Country:US
Practice Address - Phone:413-231-4142
Practice Address - Fax:413-748-3052
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer