MEDICARE: CAROLE EASTER

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	103K00000X	Behavior Analyst	0125054

General Provider Information

NPI Number	:	1417292566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLE EASTER

Provider Business Mailing Address
First Line	:	3472 RESEARCH PKWY
Second Line	:	104-122
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1066
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3472 RESEARCH PKWY
Second Line	:	104-122
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1066
Country	:	US
Telephone Number	:	719-359-2336
Fax Number	:

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

Provider Enumeration Date	:	11/30/2012
Last Update Date	:	11/30/2012

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Directions to “ CAROLE EASTER ” Practice Location

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