Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DERONDA ANN BLACK, OTR
Active Sole ProprietorDERONDA ANN BLACK, OTR is a Pediatric Occupational Therapist healthcare provider located in VICKSBURG, Michigan. NPI 1316114150 is currently active in the NPPES registry. Verify at CMS.
Pediatric Occupational Therapist · VICKSBURG, MI
Registration Details
- NPI Number
- 1316114150
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- May 12, 2008 (18.258082462033 yrs)
- Last Updated
- May 12, 2008
- License
-
31004281A (IN)
- Sole Proprietor
- Yes
Practice Information
- Address
-
14416 PORTAGE RDVICKSBURG, MI, 490979732Browse MI providers · Browse ZIP 49097
- Phone
- 2696491848
- Fax
- 2696491848
- Primary Specialty
-
Pediatric Occupational Therapist
225XP0200X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.