Basic Information
Provider Information
NPI: 1003292053
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RUEDIGER
FirstName: DEBORAH
MiddleName: E.
NamePrefix:  
NameSuffix:  
Credential: O.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 851 PENNIMAN AVE
Address2:  
City: PLYMOUTH
State: MI
PostalCode: 481701621
CountryCode: US
TelephoneNumber: 8778648171
FaxNumber: 9895095965
Practice Location
Address1: 3000 MONROE AVE NE
Address2:  
City: GRAND RAPIDS
State: MI
PostalCode: 495053313
CountryCode: US
TelephoneNumber: 8778648171
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/31/2015
LastUpdateDate: 07/31/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X5201006731MIY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


Home