Provider Demographics
NPI:1285115253
Name:BARAHONA, JAMIE LEA (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LEA
Last Name:BARAHONA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LEA
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:343 E SMITH ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2942
Mailing Address - Country:US
Mailing Address - Phone:615-509-3443
Mailing Address - Fax:
Practice Address - Street 1:370 OLD SHACKLE ISLAND RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3082
Practice Address - Country:US
Practice Address - Phone:615-824-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3097224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant