Provider Demographics
NPI:1285829317
Name:LUCERO, DEBORAH MICHELLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MICHELLE
Last Name:LUCERO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4148 E SHEFFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2383
Mailing Address - Country:US
Mailing Address - Phone:480-988-7470
Mailing Address - Fax:
Practice Address - Street 1:3341 E QUEEN CREEK RD
Practice Address - Street 2:SUITE 109
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-8501
Practice Address - Country:US
Practice Address - Phone:480-621-8361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3967224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant