Provider Demographics
NPI:1578607651
Name:KNICOS, DEBRA (MA ATR-BC LCAT)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:KNICOS
Suffix:
Gender:F
Credentials:MA ATR-BC LCAT
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:KNICOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA ATR-BC LCAT
Mailing Address - Street 1:1274 FOX GAP RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-6004
Mailing Address - Country:US
Mailing Address - Phone:610-588-0313
Mailing Address - Fax:610-588-0319
Practice Address - Street 1:1274 FOX GAP RD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-6004
Practice Address - Country:US
Practice Address - Phone:610-588-0313
Practice Address - Fax:610-588-0319
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000396-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist