Provider Demographics
NPI:1285243287
Name:BARREAL, DESTINY SPIRIT
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:SPIRIT
Last Name:BARREAL
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 1:1903 NW LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-6324
Mailing Address - Country:US
Mailing Address - Phone:404-692-9671
Mailing Address - Fax:
Practice Address - Street 1:1903 NW LAKE AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-6324
Practice Address - Country:US
Practice Address - Phone:404-692-9671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18084227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered