Provider Demographics
NPI:1801260419
Name:BARNARD, ELIZABETH JEAN FOX (OTRL)
Entity type:Individual
Prefix:
First Name:ELIZABETH JEAN
Middle Name:FOX
Last Name:BARNARD
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3346 BEAUMONT RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9713
Mailing Address - Country:US
Mailing Address - Phone:734-417-9850
Mailing Address - Fax:
Practice Address - Street 1:3346 BEAUMONT RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9713
Practice Address - Country:US
Practice Address - Phone:734-417-9850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009334225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist