Provider Demographics
NPI:1205270683
Name:DZIEKIEWICZ, DEBORAH KAY (RRT)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:KAY
Last Name:DZIEKIEWICZ
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:KAY
Other - Last Name:KNOWLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:INTERCESSION CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33848-0519
Mailing Address - Country:US
Mailing Address - Phone:407-242-0330
Mailing Address - Fax:407-483-7488
Practice Address - Street 1:4984 BOND ST W
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758
Practice Address - Country:US
Practice Address - Phone:407-242-0330
Practice Address - Fax:404-483-7488
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT6447227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1205270683Medicaid