Provider Demographics
NPI:1528254927
Name:HARGIS, DENA RAE (COTA/L)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:RAE
Last Name:HARGIS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:RAE
Other - Last Name:HARGIS-SIMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:3370 N HAYDEN RD
Mailing Address - Street 2:STORE 123 BOX 753
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6632
Mailing Address - Country:US
Mailing Address - Phone:480-255-0396
Mailing Address - Fax:480-323-2305
Practice Address - Street 1:3370 N HAYDEN RD
Practice Address - Street 2:STORE 123 BOX 753
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6632
Practice Address - Country:US
Practice Address - Phone:480-255-0396
Practice Address - Fax:480-323-2305
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1999224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant