Provider Demographics
NPI:1760119853
Name:BARNETT, JAYNA (COTA)
Entity Type:Individual
Prefix:
First Name:JAYNA
Middle Name:
Last Name:BARNETT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 COOKS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CASSCOE
Mailing Address - State:AR
Mailing Address - Zip Code:72026-9627
Mailing Address - Country:US
Mailing Address - Phone:870-674-8451
Mailing Address - Fax:
Practice Address - Street 1:601 S UNION ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:AR
Practice Address - Zip Code:72042-2727
Practice Address - Country:US
Practice Address - Phone:870-946-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1865224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AROT-A1865Medicaid