Provider Demographics
NPI:1487854428
Name:SWEET, DEBORAH E (COTA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:E
Last Name:SWEET
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HAWTHORNE PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-1029
Mailing Address - Country:US
Mailing Address - Phone:618-978-3440
Mailing Address - Fax:
Practice Address - Street 1:12509 VILLAGE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1701
Practice Address - Country:US
Practice Address - Phone:314-270-7790
Practice Address - Fax:314-849-2045
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005012036224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant