Provider Demographics
NPI:1366657579
Name:CONLEY, DEEANNA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DEEANNA
Middle Name:
Last Name:CONLEY
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 1:6171 HUNTLEY RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1079
Mailing Address - Country:US
Mailing Address - Phone:614-840-0558
Mailing Address - Fax:614-840-9310
Practice Address - Street 1:6171 HUNTLEY RD
Practice Address - Street 2:SUITE E
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1079
Practice Address - Country:US
Practice Address - Phone:614-840-0558
Practice Address - Fax:614-840-9310
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-05409225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist