Provider Demographics
NPI:1003225624
Name:DURDEN, DEBORAH (COTA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DURDEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BRIGHTON DR
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-3923
Mailing Address - Country:US
Mailing Address - Phone:478-335-4243
Mailing Address - Fax:
Practice Address - Street 1:104 BRIGHTON DR
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-3923
Practice Address - Country:US
Practice Address - Phone:478-335-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA 000668224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant