Healthcare Provider Details

I. General information

NPI: 1508431685
Provider Name (Legal Business Name): DEVEAUX GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 STREET ROAD TWO GREENWOOD SQUARE/STE 107
BENSALEM PA
19020
US

IV. Provider business mailing address

1111 COOPERSKILL RD
CHERRY HILL NJ
08034-2836
US

V. Phone/Fax

Practice location:
  • Phone: 912-452-0233
  • Fax: 360-294-2955
Mailing address:
  • Phone: 609-346-0504
  • Fax: 360-294-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. BRANDI NICOLE DEVEAUX
Title or Position: OWNER
Credential:
Phone: 609-346-0504