Active NPI
Cliff D Dedeaux, OTR
- Occupational Therapist
- Hattiesburg, MS
National Provider Identifier
1972642403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT1514
- Practice address
- 1520 Adeline St
Suite B
Hattiesburg, MS 39401-6265 - Phone
- (662) 418-7547
- NPI assigned
- Feb 5, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT1514 | MS | Primary |
Addresses
Primary practice location
1520 Adeline St
Suite B
Hattiesburg, MS 39401-6265
Mailing address
1520 Adeline St
Suite B
Hattiesburg, MS 39401-6265
Phone (662) 418-7547
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972642403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1520 ADELINE ST",
"address_2": "SUITE B",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394016265",
"telephone_number": "662-418-7547"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1520 ADELINE ST",
"address_2": "SUITE B",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394016265",
"telephone_number": "662-418-7547"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDEAUX",
"first_name": "CLIFF",
"middle_name": "D",
"name_prefix": "Mr.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MS",
"license": "OT1514",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hattiesburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.