Provider Demographics
NPI:1255404034
Name:MCGAULEY, DEBORAH ANN (COTA)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:MCGAULEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 SW ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-6727
Mailing Address - Country:US
Mailing Address - Phone:321-951-8672
Mailing Address - Fax:
Practice Address - Street 1:1220 PROSPECT AVE
Practice Address - Street 2:SUITE 292
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-7396
Practice Address - Country:US
Practice Address - Phone:321-952-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 10099224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant