Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC012319 | PA |
NPI | 1003238064 |
---|---|
Provider Name | Shalyn Eakin |
First Address | Philadelphia, PA 19130-3513 |
Second Address | Philadelphia, PA 19104-3003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2014 |
Last Update Date | 10/01/2014 |