Provider Demographics
NPI:1235553819
Name:DEBRA A STATES OTR/L CLT MFRP
Entity Type:Organization
Organization Name:DEBRA A STATES OTR/L CLT MFRP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:STATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-658-3498
Mailing Address - Street 1:15428 RAYSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:JAMES CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:16657-8705
Mailing Address - Country:US
Mailing Address - Phone:814-658-3498
Mailing Address - Fax:814-658-3498
Practice Address - Street 1:15428 RAYSTOWN RD
Practice Address - Street 2:
Practice Address - City:JAMES CREEK
Practice Address - State:PA
Practice Address - Zip Code:16657-8705
Practice Address - Country:US
Practice Address - Phone:814-658-3498
Practice Address - Fax:814-658-3498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008293225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012091580001Medicaid
PA1012091580001Medicaid