Provider Demographics
NPI:1659626281
Name:DESIMONE, CARLEE BRIANN (COTA)
Entity Type:Individual
Prefix:
First Name:CARLEE
Middle Name:BRIANN
Last Name:DESIMONE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 WHEELERS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-3981
Mailing Address - Country:US
Mailing Address - Phone:540-875-7586
Mailing Address - Fax:
Practice Address - Street 1:1522 WHEELERS RIDGE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-3981
Practice Address - Country:US
Practice Address - Phone:540-875-7586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000947224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant