Provider Demographics
NPI:1255454849
Name:PUCKETT, DEBRA EAINE (OTL)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:EAINE
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:ELAINE
Other - Last Name:CASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:1597 MCCURDY AVE N
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-4429
Mailing Address - Country:US
Mailing Address - Phone:256-638-9350
Mailing Address - Fax:
Practice Address - Street 1:112 68TH ST NW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-8300
Practice Address - Country:US
Practice Address - Phone:256-997-9929
Practice Address - Fax:256-844-2994
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2140225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist