Provider Demographics
NPI:1073842605
Name:BARNEY, THERESA ELIZABETH (OT)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ELIZABETH
Last Name:BARNEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-0346
Mailing Address - Country:US
Mailing Address - Phone:860-633-1509
Mailing Address - Fax:
Practice Address - Street 1:628 CONGDON ST W
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-7939
Practice Address - Country:US
Practice Address - Phone:860-704-8132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001661225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist