Provider Demographics
NPI:1407256399
Name:OSTGARD, DEANA ANN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:DEANA
Middle Name:ANN
Last Name:OSTGARD
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 1:2929 MCDOUGALL AVE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-7410
Mailing Address - Country:US
Mailing Address - Phone:360-802-7125
Mailing Address - Fax:360-802-7140
Practice Address - Street 1:2929 MCDOUGALL AVE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-7410
Practice Address - Country:US
Practice Address - Phone:360-802-7125
Practice Address - Fax:360-802-7140
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALA 60497514224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant