Provider Demographics
NPI:1790053387
Name:FRIZZELL, DESIREE MICOLE
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:MICOLE
Last Name:FRIZZELL
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 1:6454 TAYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-3756
Mailing Address - Country:US
Mailing Address - Phone:270-590-5867
Mailing Address - Fax:
Practice Address - Street 1:6454 TAYWOOD RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-3756
Practice Address - Country:US
Practice Address - Phone:270-590-5867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist