Provider Demographics
NPI:1891905774
Name:WITSKEN, DEBBIE
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:
Last Name:WITSKEN
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 1:133 WALNUT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BETHALTO
Mailing Address - State:IL
Mailing Address - Zip Code:62010-1247
Mailing Address - Country:US
Mailing Address - Phone:618-377-0284
Mailing Address - Fax:
Practice Address - Street 1:11701 BORMAN DR
Practice Address - Street 2:SUITE 280
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4100
Practice Address - Country:US
Practice Address - Phone:888-433-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000175044225X00000X
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist