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General NPI Number Information
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NPI Number | 1124730759
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Entity Type | Individual
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Provider Name | CORI PAIGE EASTHAM
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Gender | Female
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 2480 US HIGHWAY 41 N STE 80
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City | HENDERSON
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State | KY
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Zip | 42420-2300
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Country | US
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Telephone | 270-823-3875
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 32
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City | STURGIS
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State | KY
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Zip | 42459-0032
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Country | US
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Telephone | 270-952-3043
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 163952
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License Number State | KY
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