Provider Demographics
NPI:1356592133
Name:OBST, DEBRA BRIDGETTE (OTL)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:BRIDGETTE
Last Name:OBST
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:BRIDGETTE
Other - Last Name:CONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTL
Mailing Address - Street 1:10 SALEM CIR
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-1034
Mailing Address - Country:US
Mailing Address - Phone:610-781-9072
Mailing Address - Fax:
Practice Address - Street 1:2125 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:LAURELDALE
Practice Address - State:PA
Practice Address - Zip Code:19605-2259
Practice Address - Country:US
Practice Address - Phone:610-921-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003569L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC003569LOtherOCCUPATIONAL THERAPIST STATE LICENCE