Provider Demographics
NPI:1104169630
Name:DETERS, DEBRA S (LMT)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:S
Last Name:DETERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 PEARL STREET
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:OH
Mailing Address - Zip Code:45157
Mailing Address - Country:US
Mailing Address - Phone:513-405-0530
Mailing Address - Fax:
Practice Address - Street 1:1913 PEARL STREET
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:OH
Practice Address - Zip Code:45157
Practice Address - Country:US
Practice Address - Phone:513-405-0530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.016146GD225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist