Provider Demographics
NPI:1972642403
Name:DEDEAUX, CLIFF D (OTR)
Entity type:Individual
Prefix:MR
First Name:CLIFF
Middle Name:D
Last Name:DEDEAUX
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 ADELINE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-6265
Mailing Address - Country:US
Mailing Address - Phone:662-418-7547
Mailing Address - Fax:
Practice Address - Street 1:1520 ADELINE ST
Practice Address - Street 2:SUITE B
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-6265
Practice Address - Country:US
Practice Address - Phone:662-418-7547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1514225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist