Deserae D Douglas, COTA/L, PAMs
Occupational Therapy Assistant in Lexington, TN. Individual provider (NPI-1).
NPI number1093558751
StatusActive
Last updated in NPPESJun 18, 2024
Details
- NPI
- 1093558751
- Entity type
- Individual (NPI-1)
- Name
- Deserae D Douglas
- Credential
- COTA/L, PAMs
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 18, 2024
- Certification date
- Jun 18, 2024
- Last updated
- Jun 18, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 224Z00000X | Occupational Therapy Assistant | 2238 | TN | Yes |
Practice location
727 E Church StLexington, TN 38351-1924
Phone 731-968-2004
Mailing address
727 E Church StLexington, TN 38351-1924
Phone 731-968-2004
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