Provider Demographics
NPI:1700631900
Name:BARROW, DIANA LYN
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYN
Last Name:BARROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11831 W BOX CANYON ST
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-6141
Mailing Address - Country:US
Mailing Address - Phone:406-499-2125
Mailing Address - Fax:
Practice Address - Street 1:11831 W BOX CANYON ST
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669-6141
Practice Address - Country:US
Practice Address - Phone:406-499-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist