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NPI Code Detail

MEDICARE: JONATHAN ECKBERG

MEDICARE: JONATHAN ECKBERG
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
1225X00000XOccupational Therapist116230TX
2225X00000XOccupational Therapist3411NM

General Provider Information

NPI Number : 1154797660
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN ECKBERG
Provider Business Mailing Address
First Line : 2729 PORTER AVE
Second Line :
City : EL PASO
State : TX
Zip : 79930-3625
Country : US
Telephone Number : 888-873-4221
Fax Number :
Provider Business Practice Location Address
First Line : 2729 PORTER AVE
Second Line :
City : EL PASO
State : TX
Zip : 79930-3625
Country : US
Telephone Number : 888-873-4221
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2015
Last Update Date : 08/19/2015

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