Provider Demographics
NPI:1902109606
Name:PARKER, DERRICK ADRIAN (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:ADRIAN
Last Name:PARKER
Suffix:
Gender:M
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 1:9214 ROYAL HIGHLANDS CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1782
Mailing Address - Country:US
Mailing Address - Phone:704-919-0586
Mailing Address - Fax:
Practice Address - Street 1:9214 ROYAL HIGHLANDS CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-1782
Practice Address - Country:US
Practice Address - Phone:704-919-0586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-19
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2771224Z00000X
NC6068224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant