Provider Demographics
NPI:1508070954
Name:EDER, EDDY E (COTA)
Entity Type:Individual
Prefix:
First Name:EDDY
Middle Name:E
Last Name:EDER
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MAIN ST # B
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1407
Mailing Address - Country:US
Mailing Address - Phone:845-616-9894
Mailing Address - Fax:
Practice Address - Street 1:400 W CUMMINGS PARK STE 3950
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6538
Practice Address - Country:US
Practice Address - Phone:845-313-9477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006553-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant