Healthcare Provider Details

I. General information

NPI: 1033021985
Provider Name (Legal Business Name): DEBORAH SUE MORTONSON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2765 N FRATNEY ST
MILWAUKEE WI
53212-2607
US

IV. Provider business mailing address

808 E FOX LN
MILWAUKEE WI
53217-2805
US

V. Phone/Fax

Practice location:
  • Phone: 414-267-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3361-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: