Healthcare Provider Details

I. General information

NPI: 1093095085
Provider Name (Legal Business Name): DEBRA A TUPE PHD, MPH, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 W 120TH ST APARTMENT 92
NEW YORK NY
10027-6028
US

IV. Provider business mailing address

423 W 120TH ST APARTMENT 92
NEW YORK NY
10027-6028
US

V. Phone/Fax

Practice location:
  • Phone: 212-600-0419
  • Fax: 212-305-4569
Mailing address:
  • Phone: 212-600-0419
  • Fax: 212-305-4569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3315
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: