Provider Demographics
NPI:1477826071
Name:MOTON, DEEALICE (LMT)
Entity Type:Individual
Prefix:
First Name:DEEALICE
Middle Name:
Last Name:MOTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5150 WOODSIDE EXECUTIVE CT
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-3814
Mailing Address - Country:US
Mailing Address - Phone:706-627-6005
Mailing Address - Fax:888-807-5411
Practice Address - Street 1:5150 WOODSIDE EXECUTIVE CT
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-3814
Practice Address - Country:US
Practice Address - Phone:706-627-6005
Practice Address - Fax:888-807-5411
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC9071171000000X, 2081P2900X, 225400000X
SCMAS.9071208100000X
SC90071208VP0014X
GAMT007357225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner