Provider Demographics
NPI:1720738487
Name:BARNES, CHANNON (OTR)
Entity Type:Individual
Prefix:
First Name:CHANNON
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 LONGMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-2237
Mailing Address - Country:US
Mailing Address - Phone:774-274-9494
Mailing Address - Fax:
Practice Address - Street 1:1102 WASHINGTON ST # 5438
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5438
Practice Address - Country:US
Practice Address - Phone:781-848-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14363225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist