Provider Demographics
NPI:1417358755
Name:DISUNNO, DEBORAH (OTA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DISUNNO
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:AMAGANSETT
Mailing Address - State:NY
Mailing Address - Zip Code:11930-0123
Mailing Address - Country:US
Mailing Address - Phone:631-747-7024
Mailing Address - Fax:
Practice Address - Street 1:3330 NOYAC RD
Practice Address - Street 2:BURKSHIRE COURT BUILDING C
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-1930
Practice Address - Country:US
Practice Address - Phone:631-899-3635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant