MEDICARE: CARLY EASTERDAY

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1659784999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY EASTERDAY

Provider Business Mailing Address
First Line	:	9141 CYPRESS GREEN DR
Second Line	:	SUITE # 2
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2013
Country	:	US
Telephone Number	:	904-647-1849
Fax Number	:

Provider Business Practice Location Address
First Line	:	9141 CYPRESS GREEN DR
Second Line	:	SUITE # 2
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2013
Country	:	US
Telephone Number	:	904-647-1849
Fax Number	:

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

Provider Enumeration Date	:	06/04/2014
Last Update Date	:	06/04/2014

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Directions to “ CARLY EASTERDAY ” Practice Location

Language	Start Address	Practice Location

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