Basic Information
| Provider Information | |||||||||
| NPI: | 1972235943 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COREY | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | MARY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 W PATTON ST | ||||||||
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| City: | PAXTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609571440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173691660 | ||||||||
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| Practice Location | |||||||||
| Address1: | 423 N DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | HOOPESTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609421021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172838247 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2022 | ||||||||
| LastUpdateDate: | 06/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 057.004997 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.