Provider Demographics
NPI:1043013188
Name:EASLEY, MICHELLE RENE'E
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENE'E
Last Name:EASLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 E MANHATTAN BLVD APT 7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611-3047
Mailing Address - Country:US
Mailing Address - Phone:419-508-0476
Mailing Address - Fax:
Practice Address - Street 1:3551 E MANHATTAN BLVD APT 7
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611-3047
Practice Address - Country:US
Practice Address - Phone:419-508-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services