Provider Demographics
NPI:1598175291
Name:DEINER, PAIGE LAUREN
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:LAUREN
Last Name:DEINER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 NW FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1033
Mailing Address - Country:US
Mailing Address - Phone:302-930-3055
Mailing Address - Fax:
Practice Address - Street 1:626 NW FRONT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1033
Practice Address - Country:US
Practice Address - Phone:302-930-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT-0003927225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist