Provider Demographics
NPI:1114147469
Name:ELROD, DEBORAH A (OTR L)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:ELROD
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:RAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 HIGH GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-2473
Mailing Address - Country:US
Mailing Address - Phone:816-316-5047
Mailing Address - Fax:816-316-5081
Practice Address - Street 1:CONSOLIDATED SCHOOL DIST 4
Practice Address - Street 2:1100 HIGH GROVE RD
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-2473
Practice Address - Country:US
Practice Address - Phone:816-316-5047
Practice Address - Fax:816-316-5081
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004716225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO475692037Medicaid