Provider Demographics
NPI:1881802593
Name:TE, DEEDEE DESIREE (OTR L)
Entity type:Individual
Prefix:
First Name:DEEDEE
Middle Name:DESIREE
Last Name:TE
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MADISON AVE APT 23
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1365
Mailing Address - Country:US
Mailing Address - Phone:201-982-4525
Mailing Address - Fax:
Practice Address - Street 1:425 MADISON AVE APT 23
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-1365
Practice Address - Country:US
Practice Address - Phone:201-982-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00170200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist