Provider Demographics
NPI:1750652368
Name:DERY, DYANNA DESIREE
Entity Type:Individual
Prefix:
First Name:DYANNA
Middle Name:DESIREE
Last Name:DERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DOMENIC ST
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01529-1763
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 DOMENIC ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:MA
Practice Address - Zip Code:01529-1763
Practice Address - Country:US
Practice Address - Phone:508-344-1622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3249224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant