Provider Demographics
NPI:1912201641
Name:DEMOTT, DAWN ROCHELLE (OTR)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:ROCHELLE
Last Name:DEMOTT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7409 E 84TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6632
Mailing Address - Country:US
Mailing Address - Phone:620-249-1963
Mailing Address - Fax:
Practice Address - Street 1:7409 E 84TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6632
Practice Address - Country:US
Practice Address - Phone:620-249-1963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1542174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist