Provider Demographics
NPI:1497996276
Name:HARVEY DEASON, CARLA
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:
Last Name:HARVEY DEASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 GLACIER LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1364
Mailing Address - Country:US
Mailing Address - Phone:214-622-8328
Mailing Address - Fax:214-291-8002
Practice Address - Street 1:115 GLACIER LN
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1364
Practice Address - Country:US
Practice Address - Phone:214-622-8328
Practice Address - Fax:214-291-8002
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier