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General NPI Number Information
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NPI Number | 1932648839
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Entity Type | Individual
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Provider Name | GRETA SLABACH OTR
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Gender | Female
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 205 SOUTHERN CROSS DR
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City | MIDDLEBURY
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State | IN
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Zip | 46540
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Country | US
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Telephone | 574-370-1676
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Fax |
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Provider Business Mailing Address
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Address Line | 205 SOUTHERN CROSS DR
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City | MIDDLEBURY
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State | IN
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Zip | 46540
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | U1-0001748
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License Number State | DE
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