Provider Demographics
NPI:1134604879
Name:COTTER, DEANNA JANE (MSOT, OTRL)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:JANE
Last Name:COTTER
Suffix:
Gender:F
Credentials:MSOT, OTRL
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:STICKLER
Other - Last Name:GATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOT, OTRL
Mailing Address - Street 1:300 WESTERN AVE APT K914
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-3775
Mailing Address - Country:US
Mailing Address - Phone:517-614-3244
Mailing Address - Fax:
Practice Address - Street 1:6531 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201
Practice Address - Country:US
Practice Address - Phone:517-750-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010172225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist