Healthcare Provider Details

I. General information

NPI: 1922123488
Provider Name (Legal Business Name): JOSEPH SMITH EASON JR. O.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S LEE ST
AMERICUS GA
31709-4715
US

IV. Provider business mailing address

200 MALLON RD
AMERICUS GA
31719-2166
US

V. Phone/Fax

Practice location:
  • Phone: 229-931-5901
  • Fax: 229-931-5901
Mailing address:
  • Phone: 229-938-2667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number120
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: