Provider Demographics
NPI:1861872962
Name:EASON, EMILY JEAN (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JEAN
Last Name:EASON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BCH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3135
Mailing Address - Country:US
Mailing Address - Phone:314-749-2031
Mailing Address - Fax:
Practice Address - Street 1:298 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:SATELLITE BCH
Practice Address - State:FL
Practice Address - Zip Code:32937-3135
Practice Address - Country:US
Practice Address - Phone:314-749-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17077225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist