Provider Demographics
NPI:1255362042
Name:BARKER, JARED WAYNE (LOT)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:WAYNE
Last Name:BARKER
Suffix:
Gender:M
Credentials:LOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 CENTURY WAY,
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154
Mailing Address - Country:US
Mailing Address - Phone:972-576-1005
Mailing Address - Fax:972-576-1950
Practice Address - Street 1:420 CENTURY WAY,
Practice Address - Street 2:SUITE 300
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154
Practice Address - Country:US
Practice Address - Phone:972-576-1005
Practice Address - Fax:972-576-1950
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108130225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4424OtherBCBS