Provider Demographics
NPI:1982715827
Name:EAVES, DANJA T (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DANJA
Middle Name:T
Last Name:EAVES
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 1:603 CAMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-2712
Mailing Address - Country:US
Mailing Address - Phone:864-224-8173
Mailing Address - Fax:
Practice Address - Street 1:3400 ANDERSON RD
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-7651
Practice Address - Country:US
Practice Address - Phone:864-295-9890
Practice Address - Fax:864-295-9894
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2925225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1491Medicaid