Provider Demographics
NPI:1780345181
Name:EASTERDAY, ANITA S (CRT, CPFT, C-AE-C)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:S
Last Name:EASTERDAY
Suffix:
Gender:F
Credentials:CRT, CPFT, C-AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-4568
Mailing Address - Country:US
Mailing Address - Phone:765-677-5138
Mailing Address - Fax:765-677-5138
Practice Address - Street 1:1700 E 38TH ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-4568
Practice Address - Country:US
Practice Address - Phone:765-677-5138
Practice Address - Fax:765-677-5138
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2472E0500X
IN10816372278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG