Provider Demographics
NPI:1922490051
Name:DEHETRE, DANA (COTA/L)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:DEHETRE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14840 HALEYS PL
Mailing Address - Street 2:
Mailing Address - City:HUGHESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20637-2342
Mailing Address - Country:US
Mailing Address - Phone:301-655-1453
Mailing Address - Fax:
Practice Address - Street 1:14840 HALEYS PL
Practice Address - Street 2:
Practice Address - City:HUGHESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20637-2342
Practice Address - Country:US
Practice Address - Phone:301-655-1453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01381224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant