Provider Demographics
NPI:1225406861
Name:SMITH, DEBBIE KAY (LOM)
Entity Type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:KAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-0513
Mailing Address - Country:US
Mailing Address - Phone:570-854-9498
Mailing Address - Fax:
Practice Address - Street 1:344 E 2ND ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1869
Practice Address - Country:US
Practice Address - Phone:570-854-9498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000004171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist