Provider Demographics
NPI:1063558534
Name:KOTTER, DEBRA JOHNSON (RRT)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JOHNSON
Last Name:KOTTER
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20651 LAKE PATIENCE RD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-3581
Mailing Address - Country:US
Mailing Address - Phone:747-800-1574
Mailing Address - Fax:
Practice Address - Street 1:20651 LAKE PATIENCE RD
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-3581
Practice Address - Country:US
Practice Address - Phone:747-800-1574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT13229227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885850100Medicaid