Provider Demographics
NPI:1215178488
Name:WIDMAN, DEBRA A (MS,OTR/L)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:A
Last Name:WIDMAN
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 1:37 ELBOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1904
Mailing Address - Country:US
Mailing Address - Phone:203-376-7341
Mailing Address - Fax:
Practice Address - Street 1:37 ELBOW HILL RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-1904
Practice Address - Country:US
Practice Address - Phone:203-376-7341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010196-1225X00000X
CT002628225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist