Provider Demographics
NPI:1932607132
Name:EASTERLING, KERRI MICHELLE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:MICHELLE
Last Name:EASTERLING
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 YELLOW PINE DR
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-9558
Mailing Address - Country:US
Mailing Address - Phone:601-434-9166
Mailing Address - Fax:
Practice Address - Street 1:3688 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-8246
Practice Address - Country:US
Practice Address - Phone:601-554-7566
Practice Address - Fax:604-554-7572
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3455225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist