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Individual

SHARI L EALY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MMT

Contact information

Practice address
1040 SIEVERT ST, PORTER, IN 46304-1308
(517) 420-2550
Mailing address
1040 SIEVERT ST, PORTER, IN 46304-1308
(517) 420-2550

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
057003828
IL
224Z00000X
Occupational Therapy Assistant
Primary
32002449A
IN
225700000X
Massage Therapist
N/A
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
32002449A
STATE OF INDIANA
IN
Enumeration date
08/14/2008
Last updated
07/09/2013
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