Provider Demographics
NPI:1881687838
Name:D'EAGLE, DANA SOPHIA (OT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:SOPHIA
Last Name:D'EAGLE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:SOPHIA
Other - Last Name:ACCRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:32030 23RD AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6031
Practice Address - Country:US
Practice Address - Phone:253-946-4852
Practice Address - Fax:253-946-4862
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002169225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA112691OtherDEPT OF L&I
WAAC7585OtherREGENCE B/S
WAABO7206Medicare ID - Type Unspecified