Provider Demographics
NPI:1194948448
Name:BARRICK, JANNA
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:
Last Name:BARRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 THOMAS JOHNSON DR
Mailing Address - Street 2:STE 6
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4382
Mailing Address - Country:US
Mailing Address - Phone:301-473-5945
Mailing Address - Fax:301-473-5901
Practice Address - Street 1:1562 OPOSSUMTOWN PIKE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4337
Practice Address - Country:US
Practice Address - Phone:240-566-3333
Practice Address - Fax:240-566-3892
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05121225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05121OtherLICENSE #