Provider Demographics
NPI:1013213370
Name:DEVEREUX, EMILY (OT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DEVEREUX
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:415 BENEDUM DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1503
Mailing Address - Country:US
Mailing Address - Phone:304-842-9887
Mailing Address - Fax:
Practice Address - Street 1:415 BENEDUM DR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1503
Practice Address - Country:US
Practice Address - Phone:304-842-9887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06080225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist