1124274758 NPI number — SHARI L EALY MMT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124274758 NPI number — SHARI L EALY MMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EALY
Provider First Name:
SHARI
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGAREY
Provider Other First Name:
SHARILYNN
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
COTA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1124274758
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1040 SIEVERT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46304-1308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-420-2550
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 SIEVERT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46304-1308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-420-2550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  N/A , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224Z00000X , with the licence number: 32002449A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 224Z00000X , with the licence number: 057003828 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 32002449A . This is a "STATE OF INDIANA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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