Provider Demographics
NPI:1871833210
Name:ANTHONY, DEBRA
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9440 VISCOUNT BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7049
Mailing Address - Country:US
Mailing Address - Phone:915-629-9260
Mailing Address - Fax:915-629-9785
Practice Address - Street 1:9440 VISCOUNT BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7049
Practice Address - Country:US
Practice Address - Phone:915-629-9260
Practice Address - Fax:915-629-9785
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10964225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX331042299Medicaid