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Individual

DEBORAH DIANE WADE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT

Contact information

Practice address
331 DEINHARD LN, MCCALL, ID 83638-4703
(208) 315-0863
Mailing address
PO BOX 2925, MCCALL, ID 83638-2925
(208) 315-0863

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
23763
CO
225700000X
Massage Therapist
4344
KY
225700000X
Massage Therapist
Primary
MAS-4463
ID

Other

Enumeration date
02/13/2023
Last updated
02/13/2023
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