Provider Demographics
NPI:1780981308
Name:BARNETT, MARY ELLEN (OT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:BARNETT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 WINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-9329
Mailing Address - Country:US
Mailing Address - Phone:575-257-9810
Mailing Address - Fax:
Practice Address - Street 1:705 WINGFIELD ST
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-9329
Practice Address - Country:US
Practice Address - Phone:575-257-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM458174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist