Provider Demographics
NPI:1912560749
Name:CORCORAN, BARRY WILLIAM (COTA/L)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:WILLIAM
Last Name:CORCORAN
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:BARRY
Other - Middle Name:W
Other - Last Name:CORCORAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:20 PLOVER PL
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-4830
Mailing Address - Country:US
Mailing Address - Phone:727-254-0375
Mailing Address - Fax:
Practice Address - Street 1:515 CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-2515
Practice Address - Country:US
Practice Address - Phone:727-934-4629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17054224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty