Provider Demographics
NPI:1134217144
Name:STATES, DEBRA A (OTR-L CLT MFRP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:STATES
Suffix:
Gender:F
Credentials:OTR-L CLT MFRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15428 RAYSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:JAMES CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:16657-8705
Mailing Address - Country:US
Mailing Address - Phone:814-386-9984
Mailing Address - Fax:814-299-8467
Practice Address - Street 1:608 MIFFLIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652
Practice Address - Country:US
Practice Address - Phone:814-386-9984
Practice Address - Fax:814-299-8467
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008293225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12110724OtherCAQH
PA085405Medicare ID - Type Unspecified
PA1012091580001Medicaid