Provider Demographics
NPI:1982767356
Name:DISMUKES, SELENE W (COTA L)
Entity type:Individual
Prefix:MS
First Name:SELENE
Middle Name:W
Last Name:DISMUKES
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 1:73 LODI RD
Mailing Address - Street 2:
Mailing Address - City:WESTPOINT
Mailing Address - State:TN
Mailing Address - Zip Code:38486
Mailing Address - Country:US
Mailing Address - Phone:931-766-0287
Mailing Address - Fax:
Practice Address - Street 1:NHC SCOTT
Practice Address - Street 2:BUFFALO RD
Practice Address - City:LAWERENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464
Practice Address - Country:US
Practice Address - Phone:931-762-9418
Practice Address - Fax:931-766-0573
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOTA951224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant