Provider Demographics
NPI:1346696432
Name:DEBRA A STATES, LLC
Entity Type:Organization
Organization Name:DEBRA A STATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER/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:OTR/L CLT MFRP
Authorized Official - Phone:814-386-9984
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:814-386-9984
Mailing Address - Fax:814-299-8467
Practice Address - Street 1:608 MIFFLIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16657
Practice Address - Country:US
Practice Address - Phone:814-386-9984
Practice Address - Fax:814-299-7320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12110724OtherCAQH