1881830586 NPI number — DEBORAH G POWELL NCTMB

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881830586 NPI number — DEBORAH G POWELL NCTMB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWELL
Provider First Name:
DEBORAH
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NCTMB
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881830586
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9448D W FAIRVIEW AVE # D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83704-8101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-629-2006
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9448D W FAIRVIEW AVE # D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83704-8101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-629-2006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 511654-06 . This is a "NATIONAL CERTIFICATION BOARD FOR THERAPEUTIC MASSAGE & BODYWORK" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: MX 070017 . This is a "BOISE CITY MASSAGE EXEMPT LICENSE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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