Provider Demographics
NPI:1184451932
Name:STERNS, DEEANDREA DAWNDRELL (COTA)
Entity type:Individual
Prefix:
First Name:DEEANDREA
Middle Name:DAWNDRELL
Last Name:STERNS
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 1:421 GLEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:GLENN HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:75154-5525
Mailing Address - Country:US
Mailing Address - Phone:469-386-3587
Mailing Address - Fax:
Practice Address - Street 1:200 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-5110
Practice Address - Country:US
Practice Address - Phone:469-577-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211950224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty