Healthcare Provider Details

I. General information

NPI: 1396159844
Provider Name (Legal Business Name): MELISSA EASLEY LMT/CMMP/CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WHITE CT
CANTON IL
61520-2626
US

IV. Provider business mailing address

714 N 9TH AVE
CANTON IL
61520-1435
US

V. Phone/Fax

Practice location:
  • Phone: 309-338-3953
  • Fax:
Mailing address:
  • Phone: 309-338-3953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227003112
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: