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General NPI Number Information
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NPI Number | 1821159591
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Entity Type | Individual
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Provider Name | DEBRA LYNN BLISS OTR-L
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 510 S STALEY RD STE A
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City | CHAMPAIGN
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State | IL
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Zip | 61822-9234
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Country | US
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Telephone | 217-493-4175
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Fax | 217-351-6486
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Provider Business Mailing Address
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Address Line | 1 WELSH COBB CIR
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City | WHITE HEATH
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State | IL
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Zip | 61884-9702
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Country | US
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Telephone | 217-687-4175
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State | IL
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