Provider Demographics
NPI:1164509188
Name:DEDECKER, DEB JEAN (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:DEB
Middle Name:JEAN
Last Name:DEDECKER
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 N 83RD AVE
Mailing Address - Street 2:APARTMENT 2016
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4624
Mailing Address - Country:US
Mailing Address - Phone:623-776-0159
Mailing Address - Fax:
Practice Address - Street 1:9261 W VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-2941
Practice Address - Country:US
Practice Address - Phone:623-936-9740
Practice Address - Fax:623-907-5187
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOT LICENSE #2619174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist