Provider Demographics
NPI:1528014503
Name:SEPPELT, DEBRA JS (ATC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JS
Last Name:SEPPELT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 10TH ST SW
Mailing Address - Street 2:
Mailing Address - City:HOWARD LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55349-4905
Mailing Address - Country:US
Mailing Address - Phone:320-543-2292
Mailing Address - Fax:
Practice Address - Street 1:501 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1715
Practice Address - Country:US
Practice Address - Phone:952-442-2191
Practice Address - Fax:952-442-6548
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer