Healthcare Provider Details

I. General information

NPI: 1679552566
Provider Name (Legal Business Name): DEBORAH MARIE PARONISH MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BUTLER AVE
MARTINSBURG WV
25401-9990
US

IV. Provider business mailing address

510 BUTLER AVENUE
MARTINSBURG WV
25404
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-0811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC009419
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: