IndividualActive
Deronda Black, OTR
NPI 1316114150 · Pediatric Occupational Therapist · Vicksburg, MI
Provider details
- NPI number
- 1316114150
- Entity type
- Individual
- Primary specialty
- Pediatric Occupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- OTR
- Sex
- Female
- Sole proprietor
- Yes
- License
- 31004281A (IN)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
14416 Portage Rd
Vicksburg, MI 49097-9732
Phone: (269) 649-1848
Fax: (269) 649-1848
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 202
Vicksburg, MI 49097-0202
Registry dates
- Enumerated
- 2008-05-12
- Last updated
- 2008-05-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.