Provider Demographics
NPI:1306256961
Name:GERISILO, DEBORAH (COTA/L)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GERISILO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28150 N ALMA SCHOOL PKWY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-8048
Mailing Address - Country:US
Mailing Address - Phone:480-262-0496
Mailing Address - Fax:
Practice Address - Street 1:15414 N 7TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-3519
Practice Address - Country:US
Practice Address - Phone:602-476-7519
Practice Address - Fax:602-445-4971
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5557224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant