Provider Demographics
NPI:1497083679
Name:WOLF, DEBORAH L (LMT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:WOLF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 UNION RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45322-8727
Mailing Address - Country:US
Mailing Address - Phone:937-832-8853
Mailing Address - Fax:
Practice Address - Street 1:12 W WENGER RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2754
Practice Address - Country:US
Practice Address - Phone:937-248-6349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9419225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist