Individual
DESERAE D DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L, PAMS
Contact information
Practice address
727 E CHURCH ST, LEXINGTON, TN 38351-1924
(731) 968-2004
Mailing address
727 E CHURCH ST, LEXINGTON, TN 38351-1924
(731) 968-2004
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2238
TN
Other
Enumeration date
06/18/2024
Last updated
06/18/2024
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