Provider Demographics
NPI:1578952362
Name:BARNES, SAMMIE SHARIFF JR
Entity Type:Individual
Prefix:MR
First Name:SAMMIE
Middle Name:SHARIFF
Last Name:BARNES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 TARA OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8307
Mailing Address - Country:US
Mailing Address - Phone:407-680-6826
Mailing Address - Fax:
Practice Address - Street 1:159 TARA OAKS CIR
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8307
Practice Address - Country:US
Practice Address - Phone:407-680-6826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13088224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant