Provider Demographics
NPI:1669613691
Name:BARNES, KIM LEAH (OTR/L)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:LEAH
Last Name:BARNES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 E COLTER ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1425
Mailing Address - Country:US
Mailing Address - Phone:602-277-5006
Mailing Address - Fax:
Practice Address - Street 1:5314 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2805
Practice Address - Country:US
Practice Address - Phone:602-277-5006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-22
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3557225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics