Provider Demographics
NPI:1063658540
Name:EAVES, JOAN OLIVER (OTR)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:OLIVER
Last Name:EAVES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 MEDINA DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-6838
Mailing Address - Country:US
Mailing Address - Phone:972-841-0861
Mailing Address - Fax:
Practice Address - Street 1:2301 FOREST LN
Practice Address - Street 2:SUITE 200
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-7954
Practice Address - Country:US
Practice Address - Phone:214-883-4214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102605225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist