Provider Demographics
NPI:1003033622
Name:DEAN, JENNIFER R (COTA ,L)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:R
Last Name:DEAN
Suffix:
Gender:F
Credentials:COTA ,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:BAYARD
Mailing Address - State:NM
Mailing Address - Zip Code:88023-0165
Mailing Address - Country:US
Mailing Address - Phone:505-313-3229
Mailing Address - Fax:
Practice Address - Street 1:2300 WARREN ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-1116
Practice Address - Country:US
Practice Address - Phone:541-686-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR01069401224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant