Provider Demographics
NPI:1104982248
Name:OTT, DEBORAH K (PT)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:K
Last Name:OTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5732 STUMP RD
Mailing Address - Street 2:
Mailing Address - City:PIPERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18947-1004
Mailing Address - Country:US
Mailing Address - Phone:215-766-0927
Mailing Address - Fax:215-766-0927
Practice Address - Street 1:5732 STUMP RD
Practice Address - Street 2:
Practice Address - City:PIPERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18947-1004
Practice Address - Country:US
Practice Address - Phone:215-766-0927
Practice Address - Fax:215-766-0927
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003131L2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019326520003OtherMEDICAL ASSISTANCE