Provider Demographics
NPI:1942358429
Name:TODD, DEBORAH L (OTR,L)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:TODD
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 1:1852 COMBAT DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-7451
Mailing Address - Country:US
Mailing Address - Phone:928-854-6362
Mailing Address - Fax:
Practice Address - Street 1:8450 OLIVE AVE
Practice Address - Street 2:
Practice Address - City:MOHAVE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86440-9214
Practice Address - Country:US
Practice Address - Phone:928-768-4538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2607174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist