Provider Demographics
NPI:1013458827
Name:PARRA, DEBORAH (PEDORTHIST)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:PARRA
Suffix:
Gender:F
Credentials:PEDORTHIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 S SALEM DR
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-2764
Mailing Address - Country:US
Mailing Address - Phone:708-418-0008
Mailing Address - Fax:708-418-0009
Practice Address - Street 1:3601 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3379
Practice Address - Country:US
Practice Address - Phone:708-418-0000
Practice Address - Fax:708-418-0009
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL212.000178224L00000X
224900000X, 225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter