Provider Demographics
NPI:1104337062
Name:MIDDLETON, DEMETRAS CHUNTA' (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:DEMETRAS
Middle Name:CHUNTA'
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4064 BORDEAUX CREEK CV S
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2668
Mailing Address - Country:US
Mailing Address - Phone:901-428-5701
Mailing Address - Fax:
Practice Address - Street 1:856 WILLOW TREE CIR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6376
Practice Address - Country:US
Practice Address - Phone:901-794-7988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4400225200000X
TN5535225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant