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General NPI Number Information
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NPI Number | 1972235943
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Entity Type | Individual
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Provider Name | DEBORAH MARY COREY
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Gender | Female
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Dates
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Enumeration Date | 06/28/2022
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 423 N DIXIE HWY
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City | HOOPESTON
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State | IL
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Zip | 60942-1021
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Country | US
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Telephone | 217-283-8247
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Fax |
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Provider Business Mailing Address
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Address Line | 333 W PATTON ST
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City | PAXTON
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State | IL
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Zip | 60957-1440
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Country | US
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Telephone | 217-369-1660
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057.004997
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License Number State | IL
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