Provider Demographics
NPI:1740273275
Name:BEARDEN, DEBORAH J (OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:BEARDEN
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14620 JOHN HUMPHREY DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2642
Mailing Address - Country:US
Mailing Address - Phone:708-403-0010
Mailing Address - Fax:708-403-0017
Practice Address - Street 1:14620 JOHN HUMPHREY DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2642
Practice Address - Country:US
Practice Address - Phone:708-403-0010
Practice Address - Fax:708-403-0017
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL87053Medicare ID - Type UnspecifiedMEDICARE PROVIDER #