Provider Demographics
NPI:1013008168
Name:MAGISTRO, DEBRA ANN (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ANN
Last Name:MAGISTRO
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:KOCIEMBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:220 STEUBEN STREET
Mailing Address - Street 2:
Mailing Address - City:MONTOUR FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14865
Mailing Address - Country:US
Mailing Address - Phone:607-535-8616
Mailing Address - Fax:607-210-1965
Practice Address - Street 1:220 STEUBEN STREET
Practice Address - Street 2:
Practice Address - City:MONTOUR FALLS
Practice Address - State:NY
Practice Address - Zip Code:14865
Practice Address - Country:US
Practice Address - Phone:607-535-7121
Practice Address - Fax:607-210-1965
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003898225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist