Provider Demographics
NPI:1619291978
Name:EICHENLAUB, MADELYN PAIGE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:PAIGE
Last Name:EICHENLAUB
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 LEWIS RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-9056
Mailing Address - Country:US
Mailing Address - Phone:740-464-3946
Mailing Address - Fax:
Practice Address - Street 1:59 LEWIS RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-9056
Practice Address - Country:US
Practice Address - Phone:740-464-3946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA03161224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant