Provider Demographics
NPI:1720491152
Name:SANTOS, DEYLENE
Entity Type:Individual
Prefix:
First Name:DEYLENE
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17480 DALLAS PKWY
Mailing Address - Street 2:SUITE 221
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17480 DALLAS PKWY
Practice Address - Street 2:SUITE 221
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7337
Practice Address - Country:US
Practice Address - Phone:469-450-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist