Provider Demographics
NPI:1982185815
Name:VANDER MEULEN, DESIREE YVONNE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:YVONNE
Last Name:VANDER MEULEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:YVONNE
Other - Last Name:CATHEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9913 DUBLIN AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-1484
Mailing Address - Country:US
Mailing Address - Phone:575-361-4048
Mailing Address - Fax:
Practice Address - Street 1:5001 OFFICE PARK
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-4843
Practice Address - Country:US
Practice Address - Phone:432-362-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214166224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant