Provider Demographics
NPI:1104012509
Name:WEBB, DEIRDRE ANNA (OTR)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:ANNA
Last Name:WEBB
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 1:347 MCKNIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:WEST FORK
Mailing Address - State:AR
Mailing Address - Zip Code:72774-3144
Mailing Address - Country:US
Mailing Address - Phone:479-839-3349
Mailing Address - Fax:479-839-3752
Practice Address - Street 1:347 MCKNIGHT AVE
Practice Address - Street 2:
Practice Address - City:WEST FORK
Practice Address - State:AR
Practice Address - Zip Code:72774-3144
Practice Address - Country:US
Practice Address - Phone:479-839-3349
Practice Address - Fax:479-839-3752
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1060347225X00000X
AR1912225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist