Provider Demographics
NPI:1043397821
Name:GENAWAY, BARRY JOHN (COTA)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:JOHN
Last Name:GENAWAY
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10982 GRISWOLD RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14040-9722
Mailing Address - Country:US
Mailing Address - Phone:585-547-3619
Mailing Address - Fax:
Practice Address - Street 1:400 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1025
Practice Address - Country:US
Practice Address - Phone:585-786-8940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003706-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant