Provider Demographics
NPI:1497225254
Name:DEAN, RODNEY JAMES (COTA/L)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:JAMES
Last Name:DEAN
Suffix:
Gender:M
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 1:66642 E BAY RD SPC 76
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-8290
Mailing Address - Country:US
Mailing Address - Phone:920-538-4981
Mailing Address - Fax:
Practice Address - Street 1:66642 E BAY RD SPC 76
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-8290
Practice Address - Country:US
Practice Address - Phone:920-538-4981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR999962224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant