Provider Demographics
NPI:1730244690
Name:BARTH, DWAYNE EDWARD (COTA)
Entity type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:EDWARD
Last Name:BARTH
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:306 YELLOWSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-1727
Mailing Address - Country:US
Mailing Address - Phone:406-208-5103
Mailing Address - Fax:
Practice Address - Street 1:415 N 30TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1252
Practice Address - Country:US
Practice Address - Phone:406-247-3843
Practice Address - Fax:406-247-3773
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT928224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant