Provider Demographics
NPI:1285989905
Name:GRAHAM, DEANNA PULLIG (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:PULLIG
Last Name:GRAHAM
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 1:55 SAWMILL RD. SOUTH
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:AR
Mailing Address - Zip Code:72131-6009
Mailing Address - Country:US
Mailing Address - Phone:501-436-0244
Mailing Address - Fax:501-436-5113
Practice Address - Street 1:112 SOUTH 5TH ST.
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-3816
Practice Address - Country:US
Practice Address - Phone:501-436-0244
Practice Address - Fax:501-436-5113
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A679224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR193942721Medicaid