Basic Information
| Provider Information | |||||||||
| NPI: | 1578736641 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARKOW | ||||||||
| FirstName: | JANINE | ||||||||
| MiddleName: | LORI | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | COTA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BARKOW | ||||||||
| OtherFirstName: | JANINE | ||||||||
| OtherMiddleName: | LORI | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | COTA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 E HIGHLAND DR | ||||||||
| Address2: | |||||||||
| City: | OCONTO FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541541001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208483272 | ||||||||
| FaxNumber: | 9208487833 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 E HIGHLAND DR | ||||||||
| Address2: | |||||||||
| City: | OCONTO FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541541001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208483272 | ||||||||
| FaxNumber: | 9208487833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2008 | ||||||||
| LastUpdateDate: | 04/09/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 873 027 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | 40722900 | 05 | WI | MEDICAID |