Provider Demographics
NPI:1821792953
Name:DEAN, DESIREE MELISSA (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:MELISSA
Last Name:DEAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:DESIREE
Other - Middle Name:MELISSA
Other - Last Name:CARLTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1319 W LELA ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-5772
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2801 OLD GREENWOOD RD STE 14
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4560
Practice Address - Country:US
Practice Address - Phone:870-480-3703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1803224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant