Basic Information
| Provider Information | |||||||||
| NPI: | 1912155433 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNETT | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1005 KNOLL DR | ||||||||
| Address2: | |||||||||
| City: | ENDICOTT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 137601911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077852123 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23 W GLANN RD | ||||||||
| Address2: | |||||||||
| City: | APALACHIN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 137324026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077250889 | ||||||||
| FaxNumber: | 6076254251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2008 | ||||||||
| LastUpdateDate: | 10/08/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 015339-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.