Provider Demographics
NPI:1821592726
Name:BARNES, ELENA (ATC, OTR)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:ATC, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:DALZELL
Mailing Address - State:IL
Mailing Address - Zip Code:61320-9717
Mailing Address - Country:US
Mailing Address - Phone:815-878-1443
Mailing Address - Fax:
Practice Address - Street 1:1013 ADAMS ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-4304
Practice Address - Country:US
Practice Address - Phone:815-434-0857
Practice Address - Fax:815-434-2260
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0032142255A2300X
IL056.012458225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer