Provider Demographics
NPI:1518450360
Name:EVERRETT, DEANA (OT)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:EVERRETT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9424 MAGNOLIA ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7858
Mailing Address - Country:US
Mailing Address - Phone:304-906-9167
Mailing Address - Fax:
Practice Address - Street 1:9424 MAGNOLIA ESTATES DR
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-7858
Practice Address - Country:US
Practice Address - Phone:304-906-9167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8385225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist