Provider Demographics
NPI:1073092664
Name:MUENNINK, DEBORAH ELAINE (COTA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ELAINE
Last Name:MUENNINK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:ELAINE
Other - Last Name:MUENNINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 W GOODWIN AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6530
Mailing Address - Country:US
Mailing Address - Phone:361-576-0694
Mailing Address - Fax:361-576-2319
Practice Address - Street 1:535 N PARK ST
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-4363
Practice Address - Country:US
Practice Address - Phone:830-278-2505
Practice Address - Fax:830-278-4939
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208298224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant