Provider Demographics
NPI:1467797340
Name:FLEMMING, DENISE MICHELLS I (COTA)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MICHELLS
Last Name:FLEMMING
Suffix:I
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:674 EASTLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301
Mailing Address - Country:US
Mailing Address - Phone:208-734-4264
Mailing Address - Fax:208-734-0647
Practice Address - Street 1:674 EASTLAND DR
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6846
Practice Address - Country:US
Practice Address - Phone:208-734-4264
Practice Address - Fax:208-734-0647
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTA044224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant