Healthcare Provider Details

I. General information

NPI: 1548783574
Provider Name (Legal Business Name): DEANNA LYNN MCDONALD LIMA,COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3863 CLEVELAND AVE
SAINT LOUIS MO
63110-4009
US

IV. Provider business mailing address

9950 SOLAR LN
SAINT LOUIS MO
63123-6111
US

V. Phone/Fax

Practice location:
  • Phone: 314-664-3927
  • Fax:
Mailing address:
  • Phone: 314-657-8879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2017024676
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number53499
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: