Provider Demographics
NPI:1326059148
Name:STORCH, EILEEN S (OTR)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:S
Last Name:STORCH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 SAINT JAMES DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3311
Mailing Address - Country:US
Mailing Address - Phone:561-706-0650
Mailing Address - Fax:561-470-7136
Practice Address - Street 1:3030 SAINT JAMES DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3311
Practice Address - Country:US
Practice Address - Phone:561-706-0650
Practice Address - Fax:561-470-7136
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3685225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888456100Medicaid
FLZ0332ZMedicare ID - Type UnspecifiedOCCUPATIONAL THERAPIST