Provider Demographics
NPI:1912324401
Name:BARNES, CRYSTAL (OTR/L)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:SEXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6086 WHITE PINE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-6300
Mailing Address - Country:US
Mailing Address - Phone:706-662-5817
Mailing Address - Fax:
Practice Address - Street 1:5131 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-4196
Practice Address - Country:US
Practice Address - Phone:706-562-9107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004798225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist