Provider Demographics
NPI:1679764963
Name:KLESS, DEBRAH JANESE (MS OTRL)
Entity type:Individual
Prefix:MS
First Name:DEBRAH
Middle Name:JANESE
Last Name:KLESS
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SOUTH FARRAGUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3687
Mailing Address - Country:US
Mailing Address - Phone:215-222-3143
Mailing Address - Fax:215-222-7964
Practice Address - Street 1:920 SOUTH FARRAGUT STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3607
Practice Address - Country:US
Practice Address - Phone:215-222-7964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC000304L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist