Provider Demographics
NPI:1700015005
Name:DECKER, KATHY M (LMT)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:M
Last Name:DECKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-1438
Mailing Address - Country:US
Mailing Address - Phone:937-205-3122
Mailing Address - Fax:
Practice Address - Street 1:129 W PLEASANT ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1438
Practice Address - Country:US
Practice Address - Phone:937-205-3122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9543225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist