Provider Demographics
NPI:1326016916
Name:DINNELL, DEBRA J (OTRLCHT)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:J
Last Name:DINNELL
Suffix:
Gender:F
Credentials:OTRLCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 DESERT FOX DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436
Mailing Address - Country:US
Mailing Address - Phone:775-425-2869
Mailing Address - Fax:
Practice Address - Street 1:1450 E PRATER WAY
Practice Address - Street 2:STE 103, CUSTOM PHYSICAL THERAPY
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434
Practice Address - Country:US
Practice Address - Phone:775-331-1199
Practice Address - Fax:775-331-1180
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0027225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist