Provider Demographics
NPI:1659364370
Name:KRATZ, DEBORAH ELAINE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ELAINE
Last Name:KRATZ
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 CASTLEBROOKE LANE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28356-8042
Mailing Address - Country:US
Mailing Address - Phone:910-995-7695
Mailing Address - Fax:
Practice Address - Street 1:6121 CASTLEBROOKE LANE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NC
Practice Address - Zip Code:28356-8042
Practice Address - Country:US
Practice Address - Phone:910-995-7695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-28
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072-0000378225X00000X
NC6344225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11453890OtherCAQH
VT3478998OtherAETNA
VT1008318Medicaid
VTEMI5816501OtherVMC
VT5816501OtherFAHC PREFERRED
VT58507OtherBLUE CROSS BLUE SHIELD
VT0509091OtherCIGNA--CORRECTION
VT750214OtherMVP
VT5816501OtherFAHC PREFERRED