Provider Demographics
NPI:1043470255
Name:MILLER, DEBRA KAY (MSOM LAC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSOM LAC
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:KAY MILLER
Other - Last Name:THUMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSOM LAC
Mailing Address - Street 1:PO BOX 572
Mailing Address - Street 2:654 E BROADWAY AVE
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-0572
Mailing Address - Country:US
Mailing Address - Phone:715-748-6253
Mailing Address - Fax:715-748-6296
Practice Address - Street 1:654 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1525
Practice Address - Country:US
Practice Address - Phone:715-748-6253
Practice Address - Fax:715-748-6296
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI325-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist