Provider Demographics
NPI:1265032452
Name:DESAUTEL, MERCEDES ROSE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:ROSE
Last Name:DESAUTEL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:MERCEDES
Other - Middle Name:
Other - Last Name:BRAVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:2 ENGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-5218
Mailing Address - Country:US
Mailing Address - Phone:401-474-6819
Mailing Address - Fax:
Practice Address - Street 1:85 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-1634
Practice Address - Country:US
Practice Address - Phone:508-699-2740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3772224Z00000X
RI00711224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant