Active NPI
Andrea Eanes, MSOT OTR/L
- Occupational Therapist
- Winston Salem, NC
National Provider Identifier
1073906731
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 9878
- Practice address
- Medical Center Blvd
Winston Salem, NC 27157-0001 - Phone
- (336) 716-2255
- Fax
- (336) 716-3202
- NPI assigned
- Mar 5, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 0119006532 | VA | |
| Occupational Therapist | 225X00000X | 9878 | NC | Primary |
Addresses
Primary practice location
Medical Center Blvd
Winston Salem, NC 27157-0001
Mailing address
Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2255
Other practice location 1
175 Deer Run Rd
Danville, VA 24540-2863
Phone (434) 797-5531
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201216000664 | NC | Practitioner - Occupational Therapist in Private Practice | 8022420017 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0119006532 | VA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1425513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607904000000",
"number": "1073906731",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "MEDICAL CENTER BLVD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271570001",
"telephone_number": "336-716-2255",
"fax_number": "336-716-3202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MEDICAL CENTER BLVD",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271570001",
"telephone_number": "336-716-2255",
"fax_number": "336-716-3202"
}
],
"practiceLocations": [
{
"address_1": "175 Deer Run Rd",
"address_purpose": "LOCATION",
"city": "Danville",
"state": "VA",
"postal_code": "245402863",
"country_code": "US",
"telephone_number": "434-797-5531",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "EANES",
"first_name": "ANDREA",
"name_prefix": "Mrs.",
"credential": "MSOT OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-03-05",
"last_updated": "2020-12-14",
"certification_date": "2020-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "VA",
"license": "0119006532",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "9878",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.