Provider Demographics
NPI:1093402737
Name:CALDWELL, DEBORAH LYNN (RE)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:RE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7429 IRONGATE RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2112
Mailing Address - Country:US
Mailing Address - Phone:734-925-0305
Mailing Address - Fax:
Practice Address - Street 1:811 N MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1825
Practice Address - Country:US
Practice Address - Phone:734-925-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI27-04059814225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist