Provider Demographics
NPI:1124185301
Name:MILLARD, DEBORAH ANN (LMT NCTMB)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:MILLARD
Suffix:
Gender:F
Credentials:LMT NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 COUNTRY HOMES BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208
Mailing Address - Country:US
Mailing Address - Phone:509-328-1792
Mailing Address - Fax:509-328-1265
Practice Address - Street 1:6701 N COUNTRY HOMES BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4336
Practice Address - Country:US
Practice Address - Phone:509-328-1792
Practice Address - Fax:509-328-1265
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013021225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist