Provider Demographics
NPI:1144500612
Name:GARDINER, DEBORAH JOBES (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JOBES
Last Name:GARDINER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 MARTHAS VINEYARD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9341
Mailing Address - Country:US
Mailing Address - Phone:716-741-1024
Mailing Address - Fax:
Practice Address - Street 1:9600 CLARENCE CENTER RD
Practice Address - Street 2:
Practice Address - City:CLARENCE CENTER
Practice Address - State:NY
Practice Address - Zip Code:14032-9748
Practice Address - Country:US
Practice Address - Phone:716-407-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008125-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics