Active NPI
Ellen Jean Eaton, OTR
- Occupational Therapist
- South Bend, IN
National Provider Identifier
1013563568
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 31001875A
- Practice address
- 2505 E Jefferson Blvd
South Bend, IN 46615-2635 - Phone
- (574) 289-3945
- NPI assigned
- Aug 12, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 31001875A | IN | Primary |
Addresses
Primary practice location
2505 E Jefferson Blvd
South Bend, IN 46615-2635
Mailing address
15744 Sunrise TRL
Granger, IN 46530-9034
Phone (574) 360-1527
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31001875A | IN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565568000000",
"number": "1013563568",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15744 SUNRISE TRL",
"city": "GRANGER",
"state": "IN",
"postal_code": "465309034",
"telephone_number": "574-360-1527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2505 E JEFFERSON BLVD",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466152635",
"telephone_number": "574-289-3945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EATON",
"first_name": "ELLEN",
"middle_name": "JEAN",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-12",
"last_updated": "2019-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IN",
"license": "31001875A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.