Healthcare Provider Details

I. General information

NPI: 1982901773
Provider Name (Legal Business Name): KRISTEN ELIZABETH BARGER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 W HART RD
BELOIT WI
53511-2230
US

IV. Provider business mailing address

PO BOX 33
BRODHEAD WI
53520-0033
US

V. Phone/Fax

Practice location:
  • Phone: 608-365-2554
  • Fax:
Mailing address:
  • Phone: 781-405-8170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4771-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: