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NPI Code Detail

MEDICARE: MARISA THOMAS EASTER

MEDICARE:   MARISA THOMAS EASTER
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
1235Z00000XSpeech-Language Pathologist2202002096VA

General Provider Information

NPI Number : 1336654409
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISA THOMAS EASTER
Provider Business Mailing Address
First Line : 22 RAYMOND DR
Second Line :
City : HAMPTON
State : VA
Zip : 23666-2642
Country : US
Telephone Number : 757-825-1191
Fax Number :
Provider Business Practice Location Address
First Line : 1406 TODDS LN
Second Line :
City : HAMPTON
State : VA
Zip : 23666-2945
Country : US
Telephone Number : 757-825-4627
Fax Number : 757-896-6731
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2017
Last Update Date : 12/11/2017

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Directions to “ MARISA THOMAS EASTER ” Practice Location

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