Provider Demographics
NPI:1912107046
Name:FARLEY, EILEEN C (FL STATE LMT)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:C
Last Name:FARLEY
Suffix:
Gender:F
Credentials:FL STATE LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 LARAMIE ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-6392
Mailing Address - Country:US
Mailing Address - Phone:727-992-4338
Mailing Address - Fax:
Practice Address - Street 1:600 CAISSON HILL RD
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-7037
Practice Address - Country:US
Practice Address - Phone:727-992-4338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA#40221OtherLICENSED MASSAGE THERAPIS