Provider Demographics
NPI:1417328469
Name:BARNES, MARYKAY (MED, CRC, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARYKAY
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:MED, CRC, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 22ND ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2301
Mailing Address - Country:US
Mailing Address - Phone:330-323-4478
Mailing Address - Fax:
Practice Address - Street 1:3919 22ND ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2301
Practice Address - Country:US
Practice Address - Phone:330-323-4478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02477225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist