Provider Demographics
NPI:1801504949
Name:EAGENS, AMY LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:EAGENS
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 1:5824 PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-5337
Mailing Address - Country:US
Mailing Address - Phone:219-776-6669
Mailing Address - Fax:224-661-6758
Practice Address - Street 1:1175 LUTHER DR
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-5054
Practice Address - Country:US
Practice Address - Phone:219-546-2226
Practice Address - Fax:224-661-6758
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004819A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist