Provider Demographics
NPI:1578394136
Name:MOTHERSELL, DEBRA KATHLEEN
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:KATHLEEN
Last Name:MOTHERSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MOBILE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:EUCHA
Mailing Address - State:OK
Mailing Address - Zip Code:74342-3336
Mailing Address - Country:US
Mailing Address - Phone:210-670-7163
Mailing Address - Fax:
Practice Address - Street 1:400 MOBILE VISTA DR
Practice Address - Street 2:
Practice Address - City:EUCHA
Practice Address - State:OK
Practice Address - Zip Code:74342-3336
Practice Address - Country:US
Practice Address - Phone:210-670-7163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist