Healthcare Provider Details

I. General information

NPI: 1659364370
Provider Name (Legal Business Name): DEBORAH ELAINE KRATZ OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2005
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 CASTLEBROOKE LANE
LINDEN NC
28356-8042
US

IV. Provider business mailing address

6121 CASTLEBROOKE LANE
LINDEN NC
28356-8042
US

V. Phone/Fax

Practice location:
  • Phone: 910-995-7695
  • Fax:
Mailing address:
  • Phone: 910-995-7695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number072-0000378
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6344
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: