Provider Demographics
NPI:1437267895
Name:PHILLIPS, DEBORAH (OTR)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 MOREY HWY
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MI
Mailing Address - Zip Code:49235-9696
Mailing Address - Country:US
Mailing Address - Phone:517-445-2841
Mailing Address - Fax:
Practice Address - Street 1:1525 W MAUMEE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1899
Practice Address - Country:US
Practice Address - Phone:517-265-6007
Practice Address - Fax:517-265-5930
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000601225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist