Basic Information
Provider Information
NPI: 1750665089
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARTO
FirstName: EMILY
MiddleName: GRACE
NamePrefix:  
NameSuffix:  
Credential: OTR/L, CLT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4560 SE INTERNATIONAL WAY
Address2: STE. 100
City: MILWAUKIE
State: OR
PostalCode: 97222
CountryCode: US
TelephoneNumber: 9712065200
FaxNumber: 9712065203
Practice Location
Address1: 601 OKANOGAN AVENUE
Address2:  
City: WENATCHEE
State: WA
PostalCode: 98801
CountryCode: US
TelephoneNumber: 5096631171
FaxNumber: 5096646664
Other Information
ProviderEnumerationDate: 10/05/2011
LastUpdateDate: 10/05/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XOT60205347WAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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