Provider Demographics
NPI:1184225427
Name:RODDA, DEBORAH KAY
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:RODDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WESTERN ST
Mailing Address - Street 2:
Mailing Address - City:SPEARVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67876-8532
Mailing Address - Country:US
Mailing Address - Phone:620-225-9540
Mailing Address - Fax:620-227-9334
Practice Address - Street 1:2501 N 14TH AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2316
Practice Address - Country:US
Practice Address - Phone:620-225-9540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer