Basic Information
| Provider Information | |||||||||
| NPI: | 1710415393 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | EATON | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12709 WINCHESTER RD SW | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215026554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2407272249 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5230 E 66TH WAY | ||||||||
| Address2: | |||||||||
| City: | COMMERCE CITY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800222442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032891848 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2017 | ||||||||
| LastUpdateDate: | 05/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 0000921 | CO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 224Z00000X | A02184 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.