Provider Demographics
NPI:1699978635
Name:EBERLY, ANTHONY (COTAL)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:EBERLY
Suffix:
Gender:M
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2386 SUNLADEN DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-1585
Mailing Address - Country:US
Mailing Address - Phone:614-539-4482
Mailing Address - Fax:
Practice Address - Street 1:9110 DUBLIN RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9588
Practice Address - Country:US
Practice Address - Phone:614-932-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRPH.03331431183500000X
OH03102224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant