Provider Demographics
NPI:1619093317
Name:BLITZ, DEBORAH FAITH (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:FAITH
Last Name:BLITZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:FAITH
Other - Last Name:YARKON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2674 HEWLETT LN
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-4435
Mailing Address - Country:US
Mailing Address - Phone:917-613-2003
Mailing Address - Fax:
Practice Address - Street 1:2674 HEWLETT LN
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-4435
Practice Address - Country:US
Practice Address - Phone:917-613-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10584-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics