Healthcare Provider Details

I. General information

NPI: 1063558534
Provider Name (Legal Business Name): DEBRA JOHNSON KOTTER RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20651 LAKE PATIENCE RD
LAND O LAKES FL
34638-3581
US

IV. Provider business mailing address

20651 LAKE PATIENCE RD
LAND O LAKES FL
34638-3581
US

V. Phone/Fax

Practice location:
  • Phone: 747-800-1574
  • Fax:
Mailing address:
  • Phone: 747-800-1574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT13229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: