Provider Demographics
NPI:1437453289
Name:HIGGINBOTHAM, DEDREA DIANN (COTA)
Entity Type:Individual
Prefix:
First Name:DEDREA
Middle Name:DIANN
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 KEY RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-7545
Mailing Address - Country:US
Mailing Address - Phone:903-436-0464
Mailing Address - Fax:903-891-0558
Practice Address - Street 1:901 SEVEN OAKS RD
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-3237
Practice Address - Country:US
Practice Address - Phone:903-583-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208626224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant