Provider Demographics
NPI:1558733873
Name:FOX, DEBORAH M
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:FOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 BUSTLETON AVE
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1188
Mailing Address - Country:US
Mailing Address - Phone:215-613-6523
Mailing Address - Fax:215-613-6527
Practice Address - Street 1:14500 BUSTLETON AVE
Practice Address - Street 2:SUITE 1-A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-1188
Practice Address - Country:US
Practice Address - Phone:215-613-6523
Practice Address - Fax:215-613-6527
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007838224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant