Provider Demographics
NPI:1790356319
Name:HODGE, ELEANOR WINSTEAD (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:WINSTEAD
Last Name:HODGE
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 1:1612 EBENEZER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3862
Mailing Address - Country:US
Mailing Address - Phone:803-329-9500
Mailing Address - Fax:803-228-0101
Practice Address - Street 1:1612 EBENEZER RD STE 101
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3862
Practice Address - Country:US
Practice Address - Phone:803-329-9500
Practice Address - Fax:803-228-0101
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14145225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics