Provider Demographics
NPI:1407366594
Name:BARRY, AMELIE KASTNING (OT)
Entity Type:Individual
Prefix:MRS
First Name:AMELIE
Middle Name:KASTNING
Last Name:BARRY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:AMELIE
Other - Middle Name:ELIZABETH
Other - Last Name:KASTNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:322 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2404
Mailing Address - Country:US
Mailing Address - Phone:970-901-5642
Mailing Address - Fax:970-641-4596
Practice Address - Street 1:322 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2404
Practice Address - Country:US
Practice Address - Phone:970-901-5642
Practice Address - Fax:970-641-4596
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005192225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1407366594Medicaid