Basic Information
Provider Information
NPI: 1851702369
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARTON
FirstName: DAVID
MiddleName: DANIEL
NamePrefix: MR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 345A GREENWOOD ST STE B
Address2:  
City: WORCESTER
State: MA
PostalCode: 016071753
CountryCode: US
TelephoneNumber: 5083630200
FaxNumber:  
Practice Location
Address1: 345A GREENWOOD ST STE B
Address2:  
City: WORCESTER
State: MA
PostalCode: 016071753
CountryCode: US
TelephoneNumber: 5083630200
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/19/2014
LastUpdateDate: 05/19/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
222Q00000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist 

No ID Information.


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