Provider Demographics
NPI:1962863555
Name:BARKER, MICHELLE (OT-A)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BARKER
Suffix:
Gender:F
Credentials:OT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 UNION ROAD 320
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-8880
Mailing Address - Country:US
Mailing Address - Phone:870-310-8343
Mailing Address - Fax:
Practice Address - Street 1:617A W MAIN ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5713
Practice Address - Country:US
Practice Address - Phone:870-866-5497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT2016-009224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant