Provider Demographics
NPI:1992286728
Name:EASON, KORRINA ROCHELLE (COTA)
Entity type:Individual
Prefix:
First Name:KORRINA
Middle Name:ROCHELLE
Last Name:EASON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 BRINKER RD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-6120
Mailing Address - Country:US
Mailing Address - Phone:940-320-6300
Mailing Address - Fax:
Practice Address - Street 1:8711 CHERRY LEE LN
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:TX
Practice Address - Zip Code:76226-6462
Practice Address - Country:US
Practice Address - Phone:903-275-1829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213001224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant