Provider Demographics
NPI:1073989315
Name:BARNES, KRISTIN L (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:BARNES
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9396 N HIGHLINE RD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-2193
Mailing Address - Country:US
Mailing Address - Phone:715-699-5481
Mailing Address - Fax:
Practice Address - Street 1:7410 CO HWY K
Practice Address - Street 2:
Practice Address - City:SIREN
Practice Address - State:WI
Practice Address - Zip Code:54872
Practice Address - Country:US
Practice Address - Phone:715-349-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5219-27224Z00000X
WI6634-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5219-27OtherWI STATE LICENSE
WI6634-26OtherWI STATE LICENSE