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General NPI Number Information
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NPI Number | 1922123488
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Entity Type | Individual
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Provider Name | JOSEPH SMITH EASON JR. O.T.
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2001 S LEE ST
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City | AMERICUS
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State | GA
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Zip | 31709-4715
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Country | US
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Telephone | 229-931-5901
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Fax | 229-931-5901
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Provider Business Mailing Address
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Address Line | 200 MALLON RD
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City | AMERICUS
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State | GA
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Zip | 31719-2166
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Country | US
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Telephone | 229-938-2667
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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 | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | 120
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License Number State | GA
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