Healthcare Provider Details

I. General information

NPI: 1144522525
Provider Name (Legal Business Name): ADIA M BARNES OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 MICHAELS RD
RICHMOND VA
23229-4822
US

IV. Provider business mailing address

7600 AUTUMN PARK WAY
MECHANICSVILLE VA
23116-3868
US

V. Phone/Fax

Practice location:
  • Phone: 216-772-1030
  • Fax:
Mailing address:
  • Phone: 804-730-0009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201007754
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: