Provider Demographics
NPI:1790200053
Name:WARNER, DEANA MARIE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:DEANA
Middle Name:MARIE
Last Name:WARNER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:DEANA
Other - Middle Name:MARIE
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2454 MADSEN RD.
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601
Mailing Address - Country:US
Mailing Address - Phone:989-860-8587
Mailing Address - Fax:
Practice Address - Street 1:2454 MADSEN RD.
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601
Practice Address - Country:US
Practice Address - Phone:989-860-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202005930224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant