Provider Demographics
NPI:1073636072
Name:WILSON, DEBORAH LEFAY (DEVELOPMENTAL THERAP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LEFAY
Last Name:WILSON
Suffix:
Gender:F
Credentials:DEVELOPMENTAL THERAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16423 DOBSON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2512
Mailing Address - Country:US
Mailing Address - Phone:708-705-5446
Mailing Address - Fax:708-333-7783
Practice Address - Street 1:16423 DOBSON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2512
Practice Address - Country:US
Practice Address - Phone:708-705-5446
Practice Address - Fax:708-333-7783
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist