Provider Demographics
NPI:1063073864
Name:MAGALHAES, DEBORA MONTEIRO
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:MONTEIRO
Last Name:MAGALHAES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WAVERLY ST
Mailing Address - Street 2:STE 103
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721
Mailing Address - Country:US
Mailing Address - Phone:774-279-1449
Mailing Address - Fax:
Practice Address - Street 1:100 WAVERLY ST
Practice Address - Street 2:STE 103
Practice Address - City:ASHLAND
Practice Address - State:MA
Practice Address - Zip Code:01721
Practice Address - Country:US
Practice Address - Phone:508-309-7134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2021-11-22
Deactivation Date:2021-10-28
Deactivation Code:
Reactivation Date:2021-11-18
Provider Licenses
StateLicense IDTaxonomies
MA13142251S00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics