Provider Demographics
NPI:1578736641
Name:BARKOW, JANINE LORI (COTA)
Entity Type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:LORI
Last Name:BARKOW
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:JANINE
Other - Middle Name:LORI
Other - Last Name:BARKOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:100 E HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-1001
Mailing Address - Country:US
Mailing Address - Phone:920-848-3272
Mailing Address - Fax:920-848-7833
Practice Address - Street 1:100 E HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1001
Practice Address - Country:US
Practice Address - Phone:920-848-3272
Practice Address - Fax:920-848-7833
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI873 027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40722900Medicaid