Provider Demographics
NPI:1316075773
Name:DEKUBBER, LORI (ATC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:DEKUBBER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 AZALEA PL
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WESTERN WASHINGTON UNIVERSITY
Practice Address - Street 2:516 HIGH STREET
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-9066
Practice Address - Country:US
Practice Address - Phone:360-650-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer