MEDICARE: CHARLENE MCCLAIN SHERMAN MNT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	4949	OH

General Provider Information

NPI Number	:	1770582116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE MCCLAIN SHERMAN MNT

Provider Business Mailing Address
First Line	:	3909 WOODLEY RD
Second Line	:	SUITE 200
City	:	TOLEDO
State	:	OH
Zip	:	43606-1169
Country	:	US
Telephone Number	:	419-291-6767
Fax Number	:

Provider Business Practice Location Address
First Line	:	3909 WOODLEY RD
Second Line	:	SUITE 200
City	:	TOLEDO
State	:	OH
Zip	:	43606-1169
Country	:	US
Telephone Number	:	419-291-6767
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/08/2007

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