Provider Demographics
NPI:1326377086
Name:MCGINNIS, DEBRA KAY
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:KAY
Other - Last Name:MCGINNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41880 RAYBURN DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-2085
Mailing Address - Country:US
Mailing Address - Phone:248-561-8827
Mailing Address - Fax:
Practice Address - Street 1:41880 RAYBURN DR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-2085
Practice Address - Country:US
Practice Address - Phone:248-561-8827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2020-01-06
Deactivation Date:2015-08-24
Deactivation Code:
Reactivation Date:2019-09-07
Provider Licenses
StateLicense IDTaxonomies
MI5201005214225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist