Provider Demographics
NPI:1346829264
Name:VANN-VEST, DEANNA FAY (COTA/L)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:FAY
Last Name:VANN-VEST
Suffix:
Gender:F
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 1:110379 S 4750 RD
Mailing Address - Street 2:
Mailing Address - City:MULDROW
Mailing Address - State:OK
Mailing Address - Zip Code:74948-5980
Mailing Address - Country:US
Mailing Address - Phone:479-652-4577
Mailing Address - Fax:
Practice Address - Street 1:300 RANGER BLVD
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:OK
Practice Address - Zip Code:74954-4040
Practice Address - Country:US
Practice Address - Phone:918-427-5993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2293224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty