Provider Demographics
NPI:1023854353
Name:EUCKER, ETHAN KAIL (COTA)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:KAIL
Last Name:EUCKER
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TOURNAMENT TRL
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9745
Mailing Address - Country:US
Mailing Address - Phone:805-878-2140
Mailing Address - Fax:
Practice Address - Street 1:216 N G ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-5297
Practice Address - Country:US
Practice Address - Phone:360-538-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant