Provider Demographics
NPI:1285705749
Name:SLAGLE, DEBORAH A (LMT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:SLAGLE
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 1:5620 W. SOUTH RANGE RD.
Mailing Address - Street 2:P.O. BOX 33
Mailing Address - City:GREENFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44422-0033
Mailing Address - Country:US
Mailing Address - Phone:330-533-2372
Mailing Address - Fax:330-533-0403
Practice Address - Street 1:5620 W. SOUTH RANGE RD.
Practice Address - Street 2:
Practice Address - City:GREENFORD
Practice Address - State:OH
Practice Address - Zip Code:44422-0033
Practice Address - Country:US
Practice Address - Phone:330-533-2372
Practice Address - Fax:330-533-0403
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.011663225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist