Provider Demographics
NPI:1104478924
Name:BARKER, COURTNEY (DOT)
Entity type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:
Last Name:BARKER
Suffix:
Gender:F
Credentials:DOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1794 AUGUSTA CT
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4546
Mailing Address - Country:US
Mailing Address - Phone:619-654-6507
Mailing Address - Fax:
Practice Address - Street 1:1161 MAIN ST.
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243
Practice Address - Country:US
Practice Address - Phone:603-371-1447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20199225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist