Provider Demographics
NPI:1952963084
Name:DEAN, VICTORIA ASHLEY (COTA)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:ASHLEY
Last Name:DEAN
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 1:1423 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SNEEDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37869-3654
Mailing Address - Country:US
Mailing Address - Phone:423-733-4783
Mailing Address - Fax:
Practice Address - Street 1:1423 MAIN ST
Practice Address - Street 2:
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869-3654
Practice Address - Country:US
Practice Address - Phone:423-733-4783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3269224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant