Provider Demographics
NPI:1558538405
Name:EDDY, CARY ELLEN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CARY
Middle Name:ELLEN
Last Name:EDDY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 WOODY DR
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3812
Mailing Address - Country:US
Mailing Address - Phone:336-228-9562
Mailing Address - Fax:
Practice Address - Street 1:779 WOODY DR
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3812
Practice Address - Country:US
Practice Address - Phone:336-228-9562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4251225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist