Provider Demographics
NPI:1003165424
Name:THEAKER, NORMAN LEE (THD, RRT)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:LEE
Last Name:THEAKER
Suffix:
Gender:M
Credentials:THD, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7949 CEDAR ST
Mailing Address - Street 2:PO BOX 142
Mailing Address - City:VANDERBILT
Mailing Address - State:MI
Mailing Address - Zip Code:49795-5107
Mailing Address - Country:US
Mailing Address - Phone:989-350-8234
Mailing Address - Fax:
Practice Address - Street 1:7949 CEDAR ST
Practice Address - Street 2:
Practice Address - City:VANDERBILT
Practice Address - State:MI
Practice Address - Zip Code:49795-5107
Practice Address - Country:US
Practice Address - Phone:989-350-8234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4401004366227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4401004366OtherRESPIRATORY CARE