Provider Demographics
NPI:1972641884
Name:EADS, EMILY LOUISE (MS OTRL)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:LOUISE
Last Name:EADS
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70103
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87197-0103
Mailing Address - Country:US
Mailing Address - Phone:505-514-5857
Mailing Address - Fax:
Practice Address - Street 1:2703 BROADBENT PKWY NE STE J
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1600
Practice Address - Country:US
Practice Address - Phone:505-341-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2184225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics