Healthcare Provider Details

I. General information

NPI: 1558133181
Provider Name (Legal Business Name): DEBORAH OSEREFUARE EHIZIBUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 MALLERY DR
LANHAM MD
20706-3964
US

IV. Provider business mailing address

6710 MALLERY DR
LANHAM MD
20706-3964
US

V. Phone/Fax

Practice location:
  • Phone: 440-529-7889
  • Fax:
Mailing address:
  • Phone: 440-529-7889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA03331
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: