Provider Demographics
NPI:1538557327
Name:MAGNATTA, BARBARA
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:MAGNATTA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BARBARA
Other - Middle Name:CAROL
Other - Last Name:MAGNATTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:4552 VALLEY WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4633
Mailing Address - Country:US
Mailing Address - Phone:707-296-0686
Mailing Address - Fax:
Practice Address - Street 1:6400 PURDUE DR
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-7095
Practice Address - Country:US
Practice Address - Phone:707-443-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2197224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant