Provider Demographics
NPI:1841471794
Name:STALCUP, DEBORAH KAY (LMT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:STALCUP
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 1:144 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY FORD
Mailing Address - State:GA
Mailing Address - Zip Code:30455-7006
Mailing Address - Country:US
Mailing Address - Phone:912-687-2879
Mailing Address - Fax:
Practice Address - Street 1:1221 MERCHANT WAY
Practice Address - Street 2:SUIT 101
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0868
Practice Address - Country:US
Practice Address - Phone:912-489-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT002122225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist