Provider Demographics
NPI:1386779973
Name:BUA, DEBORAH L (MOT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:BUA
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:L
Other - Last Name:ROWLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:816-226-4011
Mailing Address - Fax:816-524-6115
Practice Address - Street 1:10801 E STATE ROUTE 350
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-2367
Practice Address - Country:US
Practice Address - Phone:816-737-5502
Practice Address - Fax:816-737-5504
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006011923225X00000X
KS17-01557225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
46002038OtherBCBS-KC
MO477599906Medicaid
KSKA2868053OtherMEDICARE PTAN
MOMA4370075OtherMEDICARE PTAN