Provider Demographics
NPI:1124252523
Name:DELLERE, DEBRA K (OTR)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:DELLERE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 COLLEGE AVE STE F100
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2756
Mailing Address - Country:US
Mailing Address - Phone:785-539-9669
Mailing Address - Fax:785-539-9779
Practice Address - Street 1:1133 COLLEGE AVE STE F100
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2756
Practice Address - Country:US
Practice Address - Phone:785-539-9669
Practice Address - Fax:785-539-9779
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02143225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist