Provider Demographics
NPI:1306913413
Name:GRAHAM, DEBRA NADINE (MEDICAL MASSAGE THER)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:NADINE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MEDICAL MASSAGE THER
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:NADINE
Other - Last Name:CHARBONNEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MEDICAL MASSAGE THER
Mailing Address - Street 1:296 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:TURNERS FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01376
Mailing Address - Country:US
Mailing Address - Phone:413-863-0088
Mailing Address - Fax:413-863-2244
Practice Address - Street 1:296 AVENUE A
Practice Address - Street 2:
Practice Address - City:TURNERS FALLS
Practice Address - State:MA
Practice Address - Zip Code:01376
Practice Address - Country:US
Practice Address - Phone:413-863-0088
Practice Address - Fax:413-863-2244
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist