Basic Information
| Provider Information | |||||||||
| NPI: | 1528014503 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEPPELT | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | JS | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9520 10TH ST SW | ||||||||
| Address2: | |||||||||
| City: | HOWARD LAKE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553494905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3205432292 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 S MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | WACONIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553871715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524422191 | ||||||||
| FaxNumber: | 9524426548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 1049 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.