Provider Demographics
NPI:1619106374
Name:WILLIS, DEBORAH CHARLENE (RRT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:CHARLENE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:CHARLENE
Other - Last Name:SASSANIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:1387 WALL ST
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7943
Mailing Address - Country:US
Mailing Address - Phone:704-534-0596
Mailing Address - Fax:704-243-6119
Practice Address - Street 1:1387 WALL ST
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7943
Practice Address - Country:US
Practice Address - Phone:704-534-0596
Practice Address - Fax:704-243-6119
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA-799227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered