Provider Demographics
NPI:1215077862
Name:BARLEY, KEITH EARL
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:EARL
Last Name:BARLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 GILL RD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7857
Mailing Address - Country:US
Mailing Address - Phone:870-307-5553
Mailing Address - Fax:870-793-1936
Practice Address - Street 1:990 GILL RD
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7857
Practice Address - Country:US
Practice Address - Phone:870-307-5553
Practice Address - Fax:870-793-1936
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR852225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U989Medicare UPIN