Provider Demographics
NPI:1144026493
Name:WAKEEN, DEBORAH MARIE (BA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MARIE
Last Name:WAKEEN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:MARIE
Other - Last Name:WAKEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA
Mailing Address - Street 1:5129 WASHBURN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2253
Mailing Address - Country:US
Mailing Address - Phone:760-417-0827
Mailing Address - Fax:
Practice Address - Street 1:5129 WASHBURN AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-2253
Practice Address - Country:US
Practice Address - Phone:760-417-0827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOT-2025-0003225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist