Provider Demographics
NPI:1578756177
Name:VIGH, DEBRA JOANN (MSOT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JOANN
Last Name:VIGH
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROUTE 1 BOX 107-9
Mailing Address - Street 2:WILD IRIS DEVELOPMENT
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-0000
Mailing Address - Country:US
Mailing Address - Phone:304-279-8227
Mailing Address - Fax:
Practice Address - Street 1:415 BENEDUM DRIVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330
Practice Address - Country:US
Practice Address - Phone:304-842-9887
Practice Address - Fax:304-842-9888
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1254225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVVI4257731Medicare PIN