Provider Demographics
NPI:1023715554
Name:BARR, JOAB WESLEY (COTA/L)
Entity type:Individual
Prefix:
First Name:JOAB
Middle Name:WESLEY
Last Name:BARR
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 600TH ST
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:KS
Mailing Address - Zip Code:66748-1382
Mailing Address - Country:US
Mailing Address - Phone:620-212-1986
Mailing Address - Fax:
Practice Address - Street 1:629 S PLUMMER AVE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-1928
Practice Address - Country:US
Practice Address - Phone:620-431-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-01861224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant