Provider Demographics
NPI:1801237201
Name:EBERHARDT, ADRIENNE EILEEN
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:EILEEN
Last Name:EBERHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 LARAMIE ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5682
Mailing Address - Country:US
Mailing Address - Phone:720-412-7644
Mailing Address - Fax:
Practice Address - Street 1:804 LARAMIE ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-5682
Practice Address - Country:US
Practice Address - Phone:720-412-7644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-13
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist