Provider Demographics
NPI:1093168403
Name:SCRIVEN, DEJUAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:DEJUAN
Middle Name:
Last Name:SCRIVEN
Suffix:
Gender:M
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 1:1015 GLENDALE DR APT 19C
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-6456
Mailing Address - Country:US
Mailing Address - Phone:191-232-4943
Mailing Address - Fax:
Practice Address - Street 1:707 N ELM ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3917
Practice Address - Country:US
Practice Address - Phone:336-885-0141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213957224Z00000X
FLOTA 15257224Z00000X
NC10620224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant