Provider Demographics
NPI:1568790814
Name:DYER, NADEAN R (OTR)
Entity Type:Individual
Prefix:
First Name:NADEAN
Middle Name:R
Last Name:DYER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 BROOKSFALL CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3506
Mailing Address - Country:US
Mailing Address - Phone:805-374-2292
Mailing Address - Fax:
Practice Address - Street 1:26560 AGOURA RD STE 110B
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-3530
Practice Address - Country:US
Practice Address - Phone:818-880-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist