Provider Demographics
NPI:1205980117
Name:LEWIS, EILEEN MARY (OTR)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:MARY
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:MARY
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:34 KELLY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-2005
Mailing Address - Country:US
Mailing Address - Phone:609-505-9765
Mailing Address - Fax:
Practice Address - Street 1:34 KELLY RIDGE RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-2005
Practice Address - Country:US
Practice Address - Phone:609-505-9765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00169400225X00000X, 225XP0200X, 225XF0002X, 225XN1300X
NY019179225X00000X, 225XP0200X, 225XF0002X, 225XG0600X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation