Healthcare Provider Details

I. General information

NPI: 1154366342
Provider Name (Legal Business Name): IAN DANIEL BARLOW OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 POINT JUDITH RD UNIT A13
NARRAGANSETT RI
02882-3451
US

IV. Provider business mailing address

21 JOHNSON PL
WAKEFIELD RI
02879-4001
US

V. Phone/Fax

Practice location:
  • Phone: 401-792-0900
  • Fax: 401-782-2916
Mailing address:
  • Phone: 401-862-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 00949
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: