Provider Demographics
NPI:1184430787
Name:PRUITT ROBBINS, DEIDRE (OT)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:PRUITT ROBBINS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7112 KNOLL LOOP
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-6025
Mailing Address - Country:US
Mailing Address - Phone:334-233-2545
Mailing Address - Fax:
Practice Address - Street 1:2102 SUMMIT PKWY
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7291
Practice Address - Country:US
Practice Address - Phone:334-361-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2631225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist