MEDICARE: PATTI DESHAZO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	0430	AL

General Provider Information

NPI Number	:	1376729368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATTI DESHAZO

Provider Business Mailing Address
First Line	:	7736 MADISON BLVD
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35806-2085
Country	:	US
Telephone Number	:	256-430-0019
Fax Number	:

Provider Business Practice Location Address
First Line	:	7736 MADISON BLVD
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35806-2085
Country	:	US
Telephone Number	:	256-430-0019
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2008
Last Update Date	:	01/21/2008

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Directions to “ PATTI DESHAZO ” Practice Location

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