Provider Demographics
NPI:1710415393
Name:EATON, EMILY LYNN (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:LYNN
Last Name:EATON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12709 WINCHESTER RD SW
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6554
Mailing Address - Country:US
Mailing Address - Phone:240-727-2249
Mailing Address - Fax:
Practice Address - Street 1:5230 E 66TH WAY
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-2442
Practice Address - Country:US
Practice Address - Phone:303-289-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000921224Z00000X
MDA02184224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant