Individual provider · NPI-1
Sierra Elyssa Dejean, OT, OTR/L
Occupational Therapist · Port Saint Lucie, FL
NPI number1629734470
StatusActive
Last updated in NPPESNov 12, 2024
Details
- NPI
- 1629734470
- Entity type
- Individual (NPI-1)
- Name
- Sierra Elyssa Dejean
- Credential
- OT, OTR/L
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Nov 15, 2021
- Certification date
- Nov 12, 2024
- Last updated
- Nov 12, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225X00000X | Occupational Therapist | 22498 | FL | Yes |
| 225X00000X | Occupational Therapist | OT22498 | FL |
Practice location
1701 Se Hillmoor DrPort Saint Lucie, FL 34952-7552
Phone 772-342-1435
Mailing address
735 18th CtVero Beach, FL 32962-1422
Phone 772-538-0395
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