Provider Demographics
NPI:1043802358
Name:DEWEY, SERENA JEAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:JEAN
Last Name:DEWEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 S CORBIN RD
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-8139
Mailing Address - Country:US
Mailing Address - Phone:208-978-1111
Mailing Address - Fax:
Practice Address - Street 1:398 S CORBIN RD
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-8139
Practice Address - Country:US
Practice Address - Phone:208-978-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-2345225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist