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General NPI Number Information
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NPI Number | 1104191824
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Entity Type | Individual
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Provider Name | DEANNA P DORAISWAMY OT
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Gender | Female
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 06/14/2018
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Provider Practice Location Address
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Address Line | 2961 SAINT ANTHONY DR
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City | GREEN BAY
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State | WI
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Zip | 54311
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Country | US
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Telephone | 920-468-0861
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Fax |
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Provider Business Mailing Address
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Address Line | 2060 E PLANK RD UNIT 3
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City | APPLETON
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State | WI
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Zip | 54915-7045
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Country | US
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Telephone | 920-655-7340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 4982-026
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119005787
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License Number State | VA
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