Provider Demographics
NPI:1306232202
Name:BISON, DEBORAH DURHAM (COTA)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:DURHAM
Last Name:BISON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:DEBBY
Other - Middle Name:LOU
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:11420 CLINGMAN RD
Mailing Address - Street 2:
Mailing Address - City:KEITHVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71047-7563
Mailing Address - Country:US
Mailing Address - Phone:318-518-9763
Mailing Address - Fax:
Practice Address - Street 1:11420 CLINGMAN RD
Practice Address - Street 2:
Practice Address - City:KEITHVILLE
Practice Address - State:LA
Practice Address - Zip Code:71047-7563
Practice Address - Country:US
Practice Address - Phone:318-518-9763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ20639224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant