Provider Demographics
NPI:1679603799
Name:EATON, JODI LEE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LEE
Last Name:EATON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 WOODLAND HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2495
Mailing Address - Country:US
Mailing Address - Phone:501-227-3622
Mailing Address - Fax:501-227-3601
Practice Address - Street 1:3920 WOODLAND HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-2495
Practice Address - Country:US
Practice Address - Phone:501-315-4414
Practice Address - Fax:501-315-3467
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1726225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160421721Medicaid