Provider Demographics
NPI:1043812795
Name:DEGEN, CELESTE MAE (OTR)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:MAE
Last Name:DEGEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 SEAMONS RD
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38581-7639
Mailing Address - Country:US
Mailing Address - Phone:786-325-0339
Mailing Address - Fax:
Practice Address - Street 1:776 SEAMONS RD
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:TN
Practice Address - Zip Code:38581-7639
Practice Address - Country:US
Practice Address - Phone:786-325-0339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007888225X00000X
TN6718225X00000X
FL21269225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist