Provider Demographics
NPI:1265554547
Name:REYES, DEANNA COLE (OT)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:COLE
Last Name:REYES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:COLE
Other - Last Name:MAYBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5603 W FRIENDLY AVE STE B
Mailing Address - Street 2:#274
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4252
Mailing Address - Country:US
Mailing Address - Phone:336-772-5499
Mailing Address - Fax:336-740-9099
Practice Address - Street 1:3907A W MARKET ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1303
Practice Address - Country:US
Practice Address - Phone:336-279-9008
Practice Address - Fax:336-740-9099
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4531225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301654Medicaid
NC7200380Medicaid