Provider Demographics
NPI:1013061423
Name:EAGLE, LINDA B (OTRL)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:B
Last Name:EAGLE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:T
Other - Last Name:BOLDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:101 BOGIE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-2832
Mailing Address - Country:US
Mailing Address - Phone:573-999-4925
Mailing Address - Fax:573-443-2075
Practice Address - Street 1:101 BOGIE HILLS DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-2832
Practice Address - Country:US
Practice Address - Phone:573-999-4925
Practice Address - Fax:573-443-2075
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003704225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist