Provider Demographics
NPI:1760769426
Name:TRAYNOR, DEBORAH J (COTA)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:J
Last Name:TRAYNOR
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:BLAUVELT
Mailing Address - State:NY
Mailing Address - Zip Code:10913-1509
Mailing Address - Country:US
Mailing Address - Phone:845-398-1825
Mailing Address - Fax:845-638-2728
Practice Address - Street 1:8 HARDING ST
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1509
Practice Address - Country:US
Practice Address - Phone:845-398-1825
Practice Address - Fax:845-638-2728
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004605-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant