Provider Demographics
NPI:1083101547
Name:SEALS, LEA MICHELLE (MS, RD, LD, CSP)
Entity Type:Individual
Prefix:MRS
First Name:LEA
Middle Name:MICHELLE
Last Name:SEALS
Suffix:
Gender:F
Credentials:MS, RD, LD, CSP
Other - Prefix:MS
Other - First Name:LEA
Other - Middle Name:MICHELLE
Other - Last Name:BISCHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:13159 ROEMER RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47012-9531
Mailing Address - Country:US
Mailing Address - Phone:513-310-0533
Mailing Address - Fax:
Practice Address - Street 1:518 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47012-1408
Practice Address - Country:US
Practice Address - Phone:513-310-0533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5395133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric