Provider Demographics
NPI:1659449080
Name:SURFACE, DEBORAH ANNE (OTR)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANNE
Last Name:SURFACE
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 1:431 BOYD CIR
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7022
Mailing Address - Country:US
Mailing Address - Phone:219-873-3696
Mailing Address - Fax:219-872-1938
Practice Address - Street 1:431 BOYD CIR
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7022
Practice Address - Country:US
Practice Address - Phone:219-873-3696
Practice Address - Fax:219-872-1938
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN310000932A225X00000X
IL056008095225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932114OtherBCBS
IN200655000Medicaid
IN2187460OtherUNITED HEALTHCARE
IN000000095746OtherBLUE CROSS BLUE SHIELD
IN200043890Medicaid
IN2007148410AMedicaid