Provider Demographics
NPI:1831853886
Name:WAYNE, DEBORAH (MS, OT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WAYNE
Suffix:
Gender:F
Credentials:MS, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1158 WAYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3148
Mailing Address - Country:US
Mailing Address - Phone:732-493-1919
Mailing Address - Fax:732-493-2413
Practice Address - Street 1:1158 WAYSIDE RD
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07712-3148
Practice Address - Country:US
Practice Address - Phone:732-493-1919
Practice Address - Fax:732-493-2413
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00320200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist