MEDICARE: DEBORAH MAINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA62231	FL

General Provider Information

NPI Number	:	1679859805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH MAINS

Provider Business Mailing Address
First Line	:	PO BOX 651305
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32965-1305
Country	:	US
Telephone Number	:	772-539-8668
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 6TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5922
Country	:	US
Telephone Number	:	772-539-8668
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2011
Last Update Date	:	04/25/2012

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