Provider Demographics
NPI:1770880957
Name:BLACKWELL OWENSBY, DEBORAH
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:BLACKWELL OWENSBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 CARROLLWOOD PLACE CIR
Mailing Address - Street 2:APT 107
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-3063
Mailing Address - Country:US
Mailing Address - Phone:813-962-4921
Mailing Address - Fax:
Practice Address - Street 1:2901 W BUSCH BLVD
Practice Address - Street 2:SUITE 916
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4523
Practice Address - Country:US
Practice Address - Phone:813-748-1386
Practice Address - Fax:813-343-6855
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist