Provider Demographics
NPI:1558531806
Name:BARNES, THERESA A (OTR/L)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:BARNES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 SADDLE RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-3323
Mailing Address - Country:US
Mailing Address - Phone:847-462-9750
Mailing Address - Fax:847-462-9751
Practice Address - Street 1:1149 SADDLE RIDGE TRL
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-3323
Practice Address - Country:US
Practice Address - Phone:847-462-9750
Practice Address - Fax:847-462-9751
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2015-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-001812225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist