Provider Demographics
NPI:1659799849
Name:DEARROS, JOANNA LYNN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:LYNN
Last Name:DEARROS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:JOANNA
Other - Middle Name:LYNN
Other - Last Name:BRINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1276 N 15TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3289
Mailing Address - Country:US
Mailing Address - Phone:406-587-2755
Mailing Address - Fax:406-587-2783
Practice Address - Street 1:1276 N 15TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3289
Practice Address - Country:US
Practice Address - Phone:406-587-2755
Practice Address - Fax:406-587-2783
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2115224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant