Basic Information
| Provider Information | |||||||||
| NPI: | 1992212682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARNER | ||||||||
| FirstName: | BARON | ||||||||
| MiddleName: | GRAY | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3996 IRON BRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238683709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4345945923 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1150 MARSH STREET | ||||||||
| Address2: | |||||||||
| City: | TAPPAHANNOCK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044434308 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2018 | ||||||||
| LastUpdateDate: | 01/04/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XN1300X | 0119006849 | VA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation | 225XP0019X | 0119006849 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No ID Information.