Provider Demographics
NPI:1902990468
Name:DEKOKER, TONYA MICHELE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:MICHELE
Last Name:DEKOKER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 N. 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605
Mailing Address - Country:US
Mailing Address - Phone:903-753-6635
Mailing Address - Fax:903-753-1114
Practice Address - Street 1:3202 N 4TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5143
Practice Address - Country:US
Practice Address - Phone:903-753-6635
Practice Address - Fax:903-753-1114
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110190225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand