Healthcare Provider Details

I. General information

NPI: 1205980117
Provider Name (Legal Business Name): EILEEN MARY LEWIS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EILEEN MARY KERN OTR/L

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 KELLY RIDGE RD
CARMEL NY
10512-2005
US

IV. Provider business mailing address

34 KELLY RIDGE RD
CARMEL NY
10512-2005
US

V. Phone/Fax

Practice location:
  • Phone: 609-505-9765
  • Fax:
Mailing address:
  • Phone: 609-505-9765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00169400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number46TR00169400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number019179
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number019179
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number019179
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number019179
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number019179
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number46TR00169400
License Number StateNJ
# 9
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number46TR00169400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: