Provider Demographics
NPI:1558661660
Name:GROGAN, DEBORAH (OT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GROGAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 TIMBER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-5349
Mailing Address - Country:US
Mailing Address - Phone:513-423-9496
Mailing Address - Fax:513-727-3806
Practice Address - Street 1:4710 TIMBER TRAIL DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5349
Practice Address - Country:US
Practice Address - Phone:513-423-9496
Practice Address - Fax:513-727-3806
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT521225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2285905Medicaid