Provider Demographics
NPI:1104096916
Name:HORNER, BARBARA ROSE (OT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ROSE
Last Name:HORNER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 WINTERSUN PL
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2788
Mailing Address - Country:US
Mailing Address - Phone:616-355-6612
Mailing Address - Fax:616-355-6617
Practice Address - Street 1:765 WINTERSUN PL
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2788
Practice Address - Country:US
Practice Address - Phone:616-355-6612
Practice Address - Fax:616-355-6617
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000779A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics