Provider Demographics
NPI:1336405901
Name:PETTIT, BARBARA JOAN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:JOAN
Last Name:PETTIT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:JOAN
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:16490 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:49247-9762
Mailing Address - Country:US
Mailing Address - Phone:517-547-4833
Mailing Address - Fax:
Practice Address - Street 1:16490 PLANK RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MI
Practice Address - Zip Code:49247-9762
Practice Address - Country:US
Practice Address - Phone:517-547-4833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-08
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002621225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist