Provider Demographics
NPI:1912219379
Name:CLEVELAND, DEIDRE L (LMT)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:L
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:43B BIRCH ST
Mailing Address - Street 2:SUITE 3G
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-2718
Mailing Address - Country:US
Mailing Address - Phone:603-674-2486
Mailing Address - Fax:603-537-9978
Practice Address - Street 1:43B BIRCH ST
Practice Address - Street 2:SUITE 3G
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2718
Practice Address - Country:US
Practice Address - Phone:603-674-2486
Practice Address - Fax:603-537-9978
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH2907M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist