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General NPI Number Information
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NPI Number | 1912673369
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Entity Type | Individual
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Provider Name | HEATHER CAROLYNE EASH
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Gender | Female
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 3401 E 30TH ST
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City | FARMINGTON
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State | NM
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Zip | 87402-8805
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Country | US
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Telephone | 505-486-2428
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Fax |
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Provider Business Mailing Address
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Address Line | 2341 E 16TH ST
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City | FARMINGTON
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State | NM
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Zip | 87401-7524
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Country | US
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Telephone | 505-486-2428
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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 | 4183
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License Number State | NM
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