Provider Demographics
NPI:1336940816
Name:BARRETT-WOLAK, JUANITA SHANAE
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:SHANAE
Last Name:BARRETT-WOLAK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 WHITESTONE COR
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-7193
Mailing Address - Country:US
Mailing Address - Phone:570-476-1600
Mailing Address - Fax:
Practice Address - Street 1:370 WHITESTONE COR
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7193
Practice Address - Country:US
Practice Address - Phone:570-476-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC020622225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist