Provider Demographics
NPI:1366570756
Name:LUBBEN, DEBRA LYN (OTR)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYN
Last Name:LUBBEN
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 1:51 SYCAMORE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755
Mailing Address - Country:US
Mailing Address - Phone:631-580-0659
Mailing Address - Fax:631-580-0659
Practice Address - Street 1:51 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2734
Practice Address - Country:US
Practice Address - Phone:631-580-0659
Practice Address - Fax:631-580-0659
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist