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General NPI Number Information
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NPI Number | 1508437658
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Entity Type | Individual
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Provider Name | KELLY C EASTERLING OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 900 JOHNSON ST
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City | TALLULAH
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State | LA
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Zip | 71282-4537
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Country | US
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Telephone | 318-574-2374
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Fax |
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Provider Business Mailing Address
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Address Line | 646 OAK ST
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City | MANDEVILLE
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State | LA
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Zip | 70448-5143
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Country | US
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Telephone | 985-966-1223
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | Z12268
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License Number State | LA
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