MEDICARE: DEBRA K DELLERE OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	17-02143	KS

General Provider Information

NPI Number	:	1124252523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA K DELLERE OTR

Provider Business Mailing Address
First Line	:	1133 COLLEGE AVE STE F100
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-2756
Country	:	US
Telephone Number	:	785-539-9669
Fax Number	:	785-539-9779

Provider Business Practice Location Address
First Line	:	1133 COLLEGE AVE STE F100
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-2756
Country	:	US
Telephone Number	:	785-539-9669
Fax Number	:	785-539-9779

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2009
Last Update Date	:	05/13/2009

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