Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 120 | GA |
NPI | 1922123488 |
---|---|
Provider Name | Mr. Joseph Smith Eason JR. |
First Address | Americus, GA 31719-2166 |
Second Address | Americus, GA 31709-4715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |