Provider Demographics
NPI:1679313373
Name:DEVILLE, ANNA BETH (L-COTA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:BETH
Last Name:DEVILLE
Suffix:
Gender:F
Credentials:L-COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 FIRE TOWER RD
Mailing Address - Street 2:
Mailing Address - City:AIMWELL
Mailing Address - State:LA
Mailing Address - Zip Code:71401-4806
Mailing Address - Country:US
Mailing Address - Phone:318-413-0693
Mailing Address - Fax:
Practice Address - Street 1:305 E COURT ST
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-3212
Practice Address - Country:US
Practice Address - Phone:318-628-3913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA326184224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty