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NPI Code Detail

MEDICARE: MRS. JODI LEE EATON OTRL

MEDICARE: MRS. JODI LEE EATON OTRL
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 TherapistOTR1726AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679603799
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JODI LEE EATON OTRL
Provider Business Mailing Address
First Line : 3920 WOODLAND HEIGHTS RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72212-2495
Country : US
Telephone Number : 501-227-3622
Fax Number : 501-227-3601
Provider Business Practice Location Address
First Line : 3920 WOODLAND HEIGHTS RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72212-2495
Country : US
Telephone Number : 501-315-4414
Fax Number : 501-315-3467
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 10/20/2008

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