Provider Demographics
NPI:1720112022
Name:LAVINE, DEBBIE KAY (OTD, OTR/L, CIMI)
Entity Type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:KAY
Last Name:LAVINE
Suffix:
Gender:F
Credentials:OTD, OTR/L, CIMI
Other - Prefix:MRS
Other - First Name:DEBBIE
Other - Middle Name:KAY
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR, CIMI
Mailing Address - Street 1:2401 PRISCELLA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-1278
Mailing Address - Country:US
Mailing Address - Phone:682-557-2042
Mailing Address - Fax:
Practice Address - Street 1:3840 HULEN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7277
Practice Address - Country:US
Practice Address - Phone:817-233-8224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107082225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886100500Medicaid