Provider Demographics
NPI:1013548353
Name:BARKER, KARIN JO (OTR/L)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:JO
Last Name:BARKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:GA
Mailing Address - Zip Code:30621-1734
Mailing Address - Country:US
Mailing Address - Phone:706-424-6780
Mailing Address - Fax:
Practice Address - Street 1:22 DURHAM ST
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-2423
Practice Address - Country:US
Practice Address - Phone:706-310-4103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000220OtherSTATE LICENSE