Individual
DEBRA BRODERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4560 SE INTERNATIONAL WAY, MILWAUKIE, OR 97222-4628
(971) 206-5102
(971) 206-5211
Mailing address
30 HERITAGE ROSE LN, SUISUN CITY, CA 94585-2743
(707) 422-5669
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA1878
CA
Other
Enumeration date
01/29/2014
Last updated
01/29/2014
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