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General NPI Number Information
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NPI Number | 1306039888
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Entity Type | Individual
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Provider Name | LISA JANE EATON MS OTR/L CAP
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Gender | Female
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 507 N CLARK ST
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City | POWELL
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State | WY
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Zip | 82435-1915
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Country | US
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Telephone | 970-420-9588
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Fax |
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Provider Business Mailing Address
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Address Line | 999 LANE 5
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City | POWELL
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State | WY
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Zip | 82435-9740
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Country | US
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Telephone | 970-420-9588
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAP-190
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 686
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License Number State | WY
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