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General NPI Number Information
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NPI Number | 1457871675
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Entity Type | Individual
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Provider Name | DEANNA FONTENOT
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Gender | Female
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 1915 LOHMANS CROSSING RD
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City | LAKEWAY
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State | TX
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Zip | 78734-5274
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Country | US
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Telephone | 737-707-2779
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Fax |
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Provider Business Mailing Address
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Address Line | 7915 JONES BRANCH DR APT 115
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City | MC LEAN
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State | VA
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Zip | 22102-3227
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Country | US
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Telephone |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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