Basic Information
Provider Information
NPI: 1215265152
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALARCIO
FirstName: EDEN
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: OT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2222 SULLIVAN TRL
Address2:  
City: EASTON
State: PA
PostalCode: 180407958
CountryCode: US
TelephoneNumber: 8009449782
FaxNumber: 6104382024
Practice Location
Address1: 6895 BELFORT OAKS PL
Address2:  
City: JACKSONVILLE
State: FL
PostalCode: 322166242
CountryCode: US
TelephoneNumber: 9042962384
FaxNumber: 9042962915
Other Information
ProviderEnumerationDate: 12/04/2009
LastUpdateDate: 12/04/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XOT12815FLY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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