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NPI Code Detail

MEDICARE: GENA MARIE DEAKINS

MEDICARE: GENA MARIE DEAKINS
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
1222Q00000XDevelopmental Therapist
2174400000XSpecialist

General Provider Information

NPI Number : 1902126220
Entity Type Code : Individual
Provider Name (Legal Business Name) : GENA MARIE DEAKINS
Provider Business Mailing Address
First Line : 5400 EUPER LN
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-3232
Country : US
Telephone Number : 479-755-6601
Fax Number :
Provider Business Practice Location Address
First Line : 5400 EUPER LN
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-3232
Country : US
Telephone Number : 479-755-6601
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2010
Last Update Date : 05/03/2017

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Directions to “ GENA MARIE DEAKINS ” Practice Location

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