MEDICARE: ERIC JON HEADLEY OTR/L, CHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT-6063	OH

General Provider Information

NPI Number	:	1093667594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC JON HEADLEY OTR/L, CHT

Provider Business Mailing Address
First Line	:	8655 MARKET ST
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4112
Country	:	US
Telephone Number	:	440-352-1200
Fax Number	:	440-255-3253

Provider Business Practice Location Address
First Line	:	8655 MARKET ST
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4112
Country	:	US
Telephone Number	:	440-352-1200
Fax Number	:	440-255-3253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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