Provider Demographics
NPI:1033666508
Name:DEGRAND, DARLENE
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:DEGRAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6803 N NAVARRO ST
Mailing Address - Street 2:APT # 180
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1528
Mailing Address - Country:US
Mailing Address - Phone:361-576-3304
Mailing Address - Fax:361-576-3304
Practice Address - Street 1:6803 N NAVARRO ST
Practice Address - Street 2:APT 180
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1528
Practice Address - Country:US
Practice Address - Phone:956-345-5812
Practice Address - Fax:361-576-3304
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208472224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant