Individual
KELLY SUZANNE EASTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTR-L
Contact information
Practice address
5406 MERLE HAY RD, JOHNSTON, IA 50131-1209
(515) 272-8750
(515) 727-8757
Mailing address
1100 BRIAR RDG, WEST DES MOINES, IA 50265-5787
(515) 508-0814
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
01613
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36918
WELLMARK BCBS
IA
Enumeration date
04/25/2007
Last updated
07/08/2007
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