Provider Demographics
NPI:1699428474
Name:ORCUTT, DEIDRE DENEE (BA,CPT,AMCA)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:DENEE
Last Name:ORCUTT
Suffix:
Gender:F
Credentials:BA,CPT,AMCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10810 E AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:TX
Mailing Address - Zip Code:79758-4901
Mailing Address - Country:US
Mailing Address - Phone:432-202-0321
Mailing Address - Fax:
Practice Address - Street 1:10810 E AUBURN ST
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:TX
Practice Address - Zip Code:79758-4901
Practice Address - Country:US
Practice Address - Phone:432-202-0321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2243613374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician