Provider Demographics
NPI:1982630414
Name:COUTU, DEBRA L (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:L
Last Name:COUTU
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 STEBBINS ST
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9345
Mailing Address - Country:US
Mailing Address - Phone:413-585-2724
Mailing Address - Fax:
Practice Address - Street 1:SMITH COLLEGE ATHLETICS
Practice Address - Street 2:AINSWORTH GYM
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01063-0001
Practice Address - Country:US
Practice Address - Phone:413-585-2724
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer