Provider Demographics
NPI:1467673095
Name:WHEATLEY, SANDRA LOUISE (HOME CARE PRIVIDER)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LOUISE
Last Name:WHEATLEY
Suffix:
Gender:F
Credentials:HOME CARE PRIVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 PERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-3223
Mailing Address - Country:US
Mailing Address - Phone:330-733-4961
Mailing Address - Fax:330-733-4961
Practice Address - Street 1:469 PERRY ROAD
Practice Address - Street 2:469 PERRY ROAD
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-3223
Practice Address - Country:US
Practice Address - Phone:330-733-4961
Practice Address - Fax:330-733-4961
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2313115390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program