Provider Demographics
NPI:1770821407
Name:BARKHOUSE, CHAD VINCENT (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:VINCENT
Last Name:BARKHOUSE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 CARLTON ARMS CIR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5068
Mailing Address - Country:US
Mailing Address - Phone:941-567-6789
Mailing Address - Fax:
Practice Address - Street 1:16404 SMOKEY POINT BLVD STE 111
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8417
Practice Address - Country:US
Practice Address - Phone:360-363-4234
Practice Address - Fax:360-363-4235
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60398524225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2031899Medicaid