Healthcare Provider Details

I. General information

NPI: 1679603799
Provider Name (Legal Business Name): JODI LEE EATON OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 10/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 WOODLAND HEIGHTS RD
LITTLE ROCK AR
72212-2495
US

IV. Provider business mailing address

3920 WOODLAND HEIGHTS RD
LITTLE ROCK AR
72212-2495
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-4414
  • Fax: 501-315-3467
Mailing address:
  • Phone: 501-227-3622
  • Fax: 501-227-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR1726
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: