Provider Demographics
NPI:1013133040
Name:AHLBORN, DEBRA LYNN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYNN
Last Name:AHLBORN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:LYNN
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3744 W HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2516
Mailing Address - Country:US
Mailing Address - Phone:414-282-2049
Mailing Address - Fax:
Practice Address - Street 1:3939 S 92ND ST
Practice Address - Street 2:CLEMENT MANOR
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-1455
Practice Address - Country:US
Practice Address - Phone:414-546-7346
Practice Address - Fax:414-546-1825
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI668027225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant