Healthcare Provider Details

I. General information

NPI: 1669434999
Provider Name (Legal Business Name): DEBORAH A OKIN M. ED., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 MEMORIAL AVE
LYNCHBURG VA
24501-1708
US

IV. Provider business mailing address

1683 COFFEE RD
LYNCHBURG VA
24503-5019
US

V. Phone/Fax

Practice location:
  • Phone: 434-845-8765
  • Fax:
Mailing address:
  • Phone: 434-845-8765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202001546
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: