Provider Demographics
NPI:1316759343
Name:TATEM, DEBORAH LYNN (OTA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:TATEM
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 AKIN WAY
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-5546
Mailing Address - Country:US
Mailing Address - Phone:352-895-0836
Mailing Address - Fax:
Practice Address - Street 1:1591 LOCKMEADE PL
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-5120
Practice Address - Country:US
Practice Address - Phone:813-369-5127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9367224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant