Basic Information
Provider Information
NPI: 1003141789
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HALL
FirstName: DEBRA
MiddleName: KAY
NamePrefix: MRS.
NameSuffix:  
Credential: LMT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 605 MAIN ST
Address2:  
City: CASSVILLE
State: MO
PostalCode: 656251419
CountryCode: US
TelephoneNumber: 4178475081
FaxNumber: 4178471911
Practice Location
Address1: 605 MAIN ST
Address2:  
City: CASSVILLE
State: MO
PostalCode: 656251419
CountryCode: US
TelephoneNumber: 4178475081
FaxNumber: 4178471911
Other Information
ProviderEnumerationDate: 10/13/2009
LastUpdateDate: 10/13/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225700000X2006028295MOY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist 

No ID Information.


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