Provider Demographics
NPI:1295872851
Name:HANEY, DEBORAH A (LMP)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:A
Last Name:HANEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:78 S MARKET BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-3036
Mailing Address - Country:US
Mailing Address - Phone:360-748-2246
Mailing Address - Fax:
Practice Address - Street 1:78 S MARKET BLVD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3036
Practice Address - Country:US
Practice Address - Phone:360-748-2246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005116225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA601341684OtherSTATE OF WASHINGTION
WA601341684OtherSTATE OF WASHINGTION