Provider Demographics
NPI:1598966418
Name:BARWICK, KITORIA JENNIFER (OT)
Entity Type:Individual
Prefix:MRS
First Name:KITORIA
Middle Name:JENNIFER
Last Name:BARWICK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7821 IDYLE WILD RD
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-4213
Mailing Address - Country:US
Mailing Address - Phone:618-559-1890
Mailing Address - Fax:
Practice Address - Street 1:7821 IDYLE WILD RD
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-4213
Practice Address - Country:US
Practice Address - Phone:618-559-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009176225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist