Provider Demographics
NPI:1184605107
Name:SCANLON, EILEEN (OTR L CHT)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:SCANLON
Suffix:
Gender:F
Credentials:OTR L CHT
Other - Prefix:MISS
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:MCCARRON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBA, OTR/L,CHT
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:
Mailing Address - Fax:
Practice Address - Street 1:260 BEISER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-5773
Practice Address - Country:US
Practice Address - Phone:302-741-0200
Practice Address - Fax:302-741-0245
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1 0000880225XH1200X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000041626Medicaid
084500Medicare ID - Type Unspecified