Provider Demographics
NPI:1205307568
Name:GARDNER, DEBORAH (OT/L)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9612 OVERTON DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1461
Mailing Address - Country:US
Mailing Address - Phone:301-325-0859
Mailing Address - Fax:
Practice Address - Street 1:9612 OVERTON DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1461
Practice Address - Country:US
Practice Address - Phone:301-325-0859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01419225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist