Provider Demographics
NPI:1760712228
Name:LEATHERMAN, SHANN LOURRAINE (CMT, HHP)
Entity Type:Individual
Prefix:MRS
First Name:SHANN
Middle Name:LOURRAINE
Last Name:LEATHERMAN
Suffix:
Gender:F
Credentials:CMT, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5159 E PARADISE RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-8333
Mailing Address - Country:US
Mailing Address - Phone:269-209-6084
Mailing Address - Fax:269-979-2026
Practice Address - Street 1:2510 SW CAPITAL AVE
Practice Address - Street 2:SUITE104
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4046
Practice Address - Country:US
Practice Address - Phone:269-209-6084
Practice Address - Fax:269-979-2026
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No133N00000XDietary & Nutritional Service ProvidersNutritionist