Provider Demographics
NPI:1013221068
Name:CHASE, DEBRA ELIZABETH (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ELIZABETH
Last Name:CHASE
Suffix:
Gender:F
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 1:833 CASTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:13744-1406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1977 MARSHLAND RD
Practice Address - Street 2:
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-1440
Practice Address - Country:US
Practice Address - Phone:919-637-8757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5145224Z00000X
NY008341224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant