Provider Demographics
NPI:1942508452
Name:PARKER, DECINDRA W (COTA)
Entity Type:Individual
Prefix:
First Name:DECINDRA
Middle Name:W
Last Name:PARKER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:BUCKSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04416-4094
Mailing Address - Country:US
Mailing Address - Phone:207-469-6642
Mailing Address - Fax:
Practice Address - Street 1:62 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:BUCKSPORT
Practice Address - State:ME
Practice Address - Zip Code:04416-4094
Practice Address - Country:US
Practice Address - Phone:207-469-6642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA2481224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant