Provider Demographics
NPI:1578779542
Name:TEWS, DEBORAH M (OTR)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:TEWS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:M
Other - Last Name:TEWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:10495 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-9559
Mailing Address - Country:US
Mailing Address - Phone:262-377-3257
Mailing Address - Fax:
Practice Address - Street 1:N27W5707 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2852
Practice Address - Country:US
Practice Address - Phone:262-376-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4014-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41039300Medicaid