Provider Demographics
NPI:1699896035
Name:POTTER, DEBORAH ANN (LMP)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:POTTER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:CARBONADO
Mailing Address - State:WA
Mailing Address - Zip Code:98323-0037
Mailing Address - Country:US
Mailing Address - Phone:253-686-7965
Mailing Address - Fax:
Practice Address - Street 1:818 8TH AVE
Practice Address - Street 2:
Practice Address - City:CARBONADO
Practice Address - State:WA
Practice Address - Zip Code:98323-9997
Practice Address - Country:US
Practice Address - Phone:253-686-7965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015065225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist