Provider Demographics
NPI:1568732055
Name:BREDE, DEBORA L (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DEBORA
Middle Name:L
Last Name:BREDE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-691 KEAAHALA RD RM 30
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3569
Mailing Address - Country:US
Mailing Address - Phone:808-233-5495
Mailing Address - Fax:808-233-5494
Practice Address - Street 1:45-691 KEAAHALA RD RM 30
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3569
Practice Address - Country:US
Practice Address - Phone:808-233-5495
Practice Address - Fax:808-233-5494
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT 160225X00000X
HI0T 160225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist