Provider Demographics
NPI:1164941134
Name:HOUGHTON, DEIDRE (OT)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:HOUGHTON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:DEIDRE
Other - Middle Name:
Other - Last Name:PLEDGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:534 OWL CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-6285
Mailing Address - Country:US
Mailing Address - Phone:770-361-4124
Mailing Address - Fax:678-290-5587
Practice Address - Street 1:534 OWL CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-6285
Practice Address - Country:US
Practice Address - Phone:770-361-4124
Practice Address - Fax:678-290-5587
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
GA005938225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
271565429OtherOCCUPATIONAL THERAPY
GA271565429Medicaid