Provider Demographics
NPI:1013924661
Name:PICKERING, DEBORAH ANN (MS, ATC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:PICKERING
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 1:216 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-8638
Mailing Address - Country:US
Mailing Address - Phone:315-657-5877
Mailing Address - Fax:
Practice Address - Street 1:170 MAIN STREET
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NY
Practice Address - Zip Code:13026
Practice Address - Country:US
Practice Address - Phone:315-364-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001032-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer