Provider Demographics
NPI:1598497992
Name:BARNES, TINA DENISE (COTA/L)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:DENISE
Last Name:BARNES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:DENISE
Other - Last Name:BOYNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1218 CRESTMARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-4426
Mailing Address - Country:US
Mailing Address - Phone:478-697-6949
Mailing Address - Fax:
Practice Address - Street 1:156 PINE KNOLL DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-2451
Practice Address - Country:US
Practice Address - Phone:770-832-8243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001130224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant