Provider Demographics
NPI:1376054403
Name:PROX, DEBRA LYNN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYNN
Last Name:PROX
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:LYNN
Other - Last Name:PROX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:W300N8731 COUNTY RD E
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-9512
Mailing Address - Country:US
Mailing Address - Phone:262-966-2071
Mailing Address - Fax:
Practice Address - Street 1:2130 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-7904
Practice Address - Country:US
Practice Address - Phone:262-338-0092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2562-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist