Provider Demographics
NPI:1033257365
Name:RIDER, BARBARA ABERNATHY (PHD, OT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ABERNATHY
Last Name:RIDER
Suffix:
Gender:F
Credentials:PHD, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 WINCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2120
Mailing Address - Country:US
Mailing Address - Phone:269-344-6471
Mailing Address - Fax:
Practice Address - Street 1:2622 WINCHELL AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2120
Practice Address - Country:US
Practice Address - Phone:269-344-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1755210225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
053530OtherAMERICAN OT ASSOCIATION
MI1755210OtherREGISTRATION
MI1755210OtherREGISTRATION