Provider Demographics
NPI:1871204800
Name:DARR, DESAREE A (COTA/L)
Entity type:Individual
Prefix:
First Name:DESAREE
Middle Name:A
Last Name:DARR
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 STATE ROUTE 412
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-9000
Mailing Address - Country:US
Mailing Address - Phone:419-575-8658
Mailing Address - Fax:
Practice Address - Street 1:1761 STATE ROUTE 412
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-9000
Practice Address - Country:US
Practice Address - Phone:419-575-8658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA006156224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant