Provider Demographics
NPI:1972885218
Name:CORLETT, LINDA (LAC, AP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CORLETT
Suffix:
Gender:F
Credentials:LAC, AP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:BLAHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, AP
Mailing Address - Street 1:7106 MAYSDAY AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-1407
Mailing Address - Country:US
Mailing Address - Phone:440-884-0280
Mailing Address - Fax:
Practice Address - Street 1:7380 ENGLE RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3429
Practice Address - Country:US
Practice Address - Phone:440-239-3438
Practice Address - Fax:440-239-3440
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000005171100000X
FLAP1413171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist