Individual
THERESA HARNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17049 N STATE ROAD 245, DALE, IN 47523
(812) 686-2476
Mailing address
PO BOX 167, SANTA CLAUS, IN 47579-0167
(812) 686-2476
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200863260
—
IN
Enumeration date
06/05/2008
Last updated
06/06/2008
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