Provider Demographics
NPI:1376020701
Name:BARRETT, MARCIA RITZERT (OTR, CLT)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:RITZERT
Last Name:BARRETT
Suffix:
Gender:F
Credentials:OTR, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30980 CHADWICK DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4332
Mailing Address - Country:US
Mailing Address - Phone:574-315-2056
Mailing Address - Fax:
Practice Address - Street 1:111 W JEFFERSON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1993
Practice Address - Country:US
Practice Address - Phone:574-315-2056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006932225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist