Provider Demographics
NPI:1447567987
Name:LEWIS, DEBORAH M (OTA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:LEWIS
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 1:30 CEDAR KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-2814
Mailing Address - Country:US
Mailing Address - Phone:646-232-9656
Mailing Address - Fax:845-787-5561
Practice Address - Street 1:30 CEDAR KNOLL DR
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589-2814
Practice Address - Country:US
Practice Address - Phone:646-232-9656
Practice Address - Fax:845-787-5561
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004667-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant