Provider Demographics
NPI:1558358416
Name:DEGRAFF, DENISE (OT)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:DEGRAFF
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 1:1356 MIMOSA LANE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 S MOUNT OLIVE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3602
Practice Address - Country:US
Practice Address - Phone:479-524-6306
Practice Address - Fax:479-524-6096
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR189225X00000X
OK700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W431Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPY