Provider Demographics
NPI:1619232600
Name:RATCLIFF, DESNA (MS, OT)
Entity Type:Individual
Prefix:
First Name:DESNA
Middle Name:
Last Name:RATCLIFF
Suffix:
Gender:F
Credentials:MS, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 N LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-7762
Mailing Address - Country:US
Mailing Address - Phone:812-701-4666
Mailing Address - Fax:
Practice Address - Street 1:395 N LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-7762
Practice Address - Country:US
Practice Address - Phone:812-701-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000054A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist