Provider Demographics
NPI:1043356306
Name:BAUCH, DEBORAH ROSE (OTR)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ROSE
Last Name:BAUCH
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 1:78 MACINTOSH LN
Mailing Address - Street 2:
Mailing Address - City:BOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01719-2012
Mailing Address - Country:US
Mailing Address - Phone:978-857-5502
Mailing Address - Fax:
Practice Address - Street 1:524 MAIN ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3301
Practice Address - Country:US
Practice Address - Phone:978-266-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3016225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics