Healthcare Provider Details

I. General information

NPI: 1093874463
Provider Name (Legal Business Name): STEVE & DONNA B. EAKIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 MENDOCINO AVE SUITE B
SANTA ROSA CA
95403-3157
US

IV. Provider business mailing address

2305 MENDOCINO AVE SUITE B
SANTA ROSA CA
95403-3157
US

V. Phone/Fax

Practice location:
  • Phone: 707-544-2637
  • Fax: 707-544-2088
Mailing address:
  • Phone: 707-544-2637
  • Fax: 707-544-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN E EAKIN
Title or Position: OWNER
Credential: OTR
Phone: 707-544-2637