Provider Demographics
NPI:1801935978
Name:BOHAN, EILEEN MARY (OT)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARY
Last Name:BOHAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2459 SUNDERLAND RD
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-3643
Mailing Address - Country:US
Mailing Address - Phone:407-579-1326
Mailing Address - Fax:
Practice Address - Street 1:2459 SUNDERLAND RD
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-3643
Practice Address - Country:US
Practice Address - Phone:407-579-1326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8692225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics