Healthcare Provider Details

I. General information

NPI: 1497894158
Provider Name (Legal Business Name): DEBORAH ANN CAHILL OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY MC 5068
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

3020 CHILDRENS WAY MC 5068
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-5829
  • Fax:
Mailing address:
  • Phone: 858-966-5829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberAA277517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: