Provider Demographics
NPI:1679218283
Name:CARPENTER, DAJUAN WESLEY (COTA)
Entity Type:Individual
Prefix:
First Name:DAJUAN
Middle Name:WESLEY
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 MICHIGAN AVE # B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-1327
Mailing Address - Country:US
Mailing Address - Phone:614-425-9495
Mailing Address - Fax:
Practice Address - Street 1:5070 LAMME RD
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-3266
Practice Address - Country:US
Practice Address - Phone:937-293-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant