Provider Demographics
NPI:1508437658
Name:EASTERLING, KELLY C (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:C
Last Name:EASTERLING
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 OAK ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-5143
Mailing Address - Country:US
Mailing Address - Phone:985-966-1223
Mailing Address - Fax:
Practice Address - Street 1:900 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-4537
Practice Address - Country:US
Practice Address - Phone:318-574-2374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12268225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist