Provider Demographics
NPI:1063662740
Name:SIMCOE, DEBRA JEAN (LMT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JEAN
Last Name:SIMCOE
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 1:2801 BLEVINS GAP RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-2073
Mailing Address - Country:US
Mailing Address - Phone:502-933-3649
Mailing Address - Fax:
Practice Address - Street 1:8033 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-1344
Practice Address - Country:US
Practice Address - Phone:502-664-4573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2475225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist