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General NPI Number Information
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NPI Number | 1801504949
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Entity Type | Individual
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Provider Name | AMY LYNN EAGENS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/08/2022
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 1175 LUTHER DR
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City | CROWN POINT
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State | IN
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Zip | 46307-5054
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Country | US
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Telephone | 219-546-2226
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Fax | 224-661-6758
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Provider Business Mailing Address
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Address Line | 5824 PHILLIPS RD
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City | SCHERERVILLE
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State | IN
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Zip | 46375-5337
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Country | US
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Telephone | 219-776-6669
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Fax | 224-661-6758
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 31004819A
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License Number State | IN
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