Provider Demographics
NPI:1205031069
Name:EARL, ELIZABETH JOAN
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JOAN
Last Name:EARL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 W PETTY RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-9566
Mailing Address - Country:US
Mailing Address - Phone:765-288-1770
Mailing Address - Fax:765-288-1770
Practice Address - Street 1:5000 W PETTY RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-9566
Practice Address - Country:US
Practice Address - Phone:765-288-1770
Practice Address - Fax:765-288-1770
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist