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NPI Code Detail

MEDICARE: DEBORAH WALLER OT

MEDICARE:   DEBORAH  WALLER  OT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT6545CA

General Provider Information

NPI Number : 1003899410
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH WALLER OT
Provider Business Mailing Address
First Line : 2025 SOQUEL AVE
Second Line : CRED SC3
City : SANTA CRUZ
State : CA
Zip : 95062-1323
Country : US
Telephone Number : 831-479-6603
Fax Number :
Provider Business Practice Location Address
First Line : 1529 SEABRIGHT AVE
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95062-2528
Country : US
Telephone Number : 831-458-6230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2005
Last Update Date : 11/29/2011

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