Provider Demographics
NPI:1710471859
Name:BARR, MARIAH KAY (COTA/L)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:KAY
Last Name:BARR
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 KALESEY CT LOT 39
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-9279
Mailing Address - Country:US
Mailing Address - Phone:618-895-4228
Mailing Address - Fax:
Practice Address - Street 1:6205 MINERAL POINT RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4576
Practice Address - Country:US
Practice Address - Phone:608-230-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057004404224Z00000X
WI5442224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL057004404OtherOTA LICENSE
WI5442OtherOTA LICENSE