Provider Demographics
NPI:1265316525
Name:BARNEY, KENYETTA SIMONE (COTA)
Entity type:Individual
Prefix:
First Name:KENYETTA
Middle Name:SIMONE
Last Name:BARNEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KENYETTA
Other - Middle Name:SIMONE
Other - Last Name:EADDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4712 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3513
Mailing Address - Country:US
Mailing Address - Phone:718-974-7218
Mailing Address - Fax:
Practice Address - Street 1:4712 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3513
Practice Address - Country:US
Practice Address - Phone:215-727-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP010697224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant