MEDICARE: MRS. DEBORAH LEE CONKLIN OTR/L

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	225XP0200X	Pediatric Occupational Therapist	46TR00004800	NJ

General Provider Information

NPI Number	:	1811269020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH LEE CONKLIN OTR/L

Provider Business Mailing Address
First Line	:	2207 NORTH RD
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-3827
Country	:	US
Telephone Number	:	732-691-7328
Fax Number	:

Provider Business Practice Location Address
First Line	:	2207 NORTH RD
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-3827
Country	:	US
Telephone Number	:	732-691-7328
Fax Number	:

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

Provider Enumeration Date	:	02/02/2012
Last Update Date	:	02/02/2012

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