Provider Demographics
NPI:1821159591
Name:BLISS, DEBRA LYNN (OTR-L)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:BLISS
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WELSH COBB CIR
Mailing Address - Street 2:
Mailing Address - City:WHITE HEATH
Mailing Address - State:IL
Mailing Address - Zip Code:61884-9702
Mailing Address - Country:US
Mailing Address - Phone:217-687-4175
Mailing Address - Fax:
Practice Address - Street 1:510 S STALEY RD STE A
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-9234
Practice Address - Country:US
Practice Address - Phone:217-493-4175
Practice Address - Fax:217-351-6486
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07432001OtherBLUE CROSS