Provider Demographics
NPI:1396954814
Name:ANGBO, DEBORAH (COTA)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:ANGBO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:ANN-VIOLA
Other - Last Name:DRAKE-ANGBO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:444 NOSTRAND AVE
Mailing Address - Street 2:1ST. FL.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1717
Mailing Address - Country:US
Mailing Address - Phone:347-715-3430
Mailing Address - Fax:
Practice Address - Street 1:350 5TH AVE
Practice Address - Street 2:SUITE 5115
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10118-0110
Practice Address - Country:US
Practice Address - Phone:866-696-8773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002092-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant