MEDICARE: DEBRA MARIE KVASNIKOFF LMT

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	121258	AK

General Provider Information

NPI Number	:	1487183059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA MARIE KVASNIKOFF LMT

Provider Business Mailing Address
First Line	:	198 W MARYDALE AVE
Second Line	:
City	:	SOLDOTNA
State	:	AK
Zip	:	99669-7501
Country	:	US
Telephone Number	:	480-773-2418
Fax Number	:	907-759-7307

Provider Business Practice Location Address
First Line	:	198 W MARYDALE AVE
Second Line	:
City	:	SOLDOTNA
State	:	AK
Zip	:	99669-7501
Country	:	US
Telephone Number	:	480-773-2418
Fax Number	:	907-759-7307

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

Provider Enumeration Date	:	06/07/2017
Last Update Date	:	01/09/2026

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