Provider Demographics
NPI:1407196660
Name:BARATANG, JOAN
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:BARATANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 SW H K DODGEN LOOP
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-7062
Mailing Address - Country:US
Mailing Address - Phone:254-774-9991
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:2010 SW H K DODGEN LOOP
Practice Address - Street 2:SUITE 201
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7062
Practice Address - Country:US
Practice Address - Phone:254-774-9991
Practice Address - Fax:817-789-6849
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105652225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456606Medicaid
TX149984001Medicaid
TX676535Medicaid
TX676535Medicaid