Provider Demographics
NPI:1437338670
Name:BODEN, DEBORAH DIANE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:DIANE
Last Name:BODEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 FOX HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:BIGLERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17307
Mailing Address - Country:US
Mailing Address - Phone:717-334-0250
Mailing Address - Fax:
Practice Address - Street 1:2990 CARLISLE PIKE
Practice Address - Street 2:CROSS KEYS VILLAGE, THE BRETHREN HOME COMMUNITY
Practice Address - City:NEW OXFORD
Practice Address - State:PA
Practice Address - Zip Code:17350-0128
Practice Address - Country:US
Practice Address - Phone:717-624-5229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP002988L224Z00000X
MDA00378224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant