Provider Demographics
NPI:1417008608
Name:HOOVER, DEBORAH JEAN (OTR)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JEAN
Last Name:HOOVER
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 1:415 ORBITING DR STE B
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-1762
Mailing Address - Country:US
Mailing Address - Phone:715-693-7178
Mailing Address - Fax:715-693-7178
Practice Address - Street 1:415 ORBITING DR STE B
Practice Address - Street 2:
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455-1762
Practice Address - Country:US
Practice Address - Phone:715-693-7178
Practice Address - Fax:715-693-7178
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1700026225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40825700Medicaid