Vicky Lynn Eikenberry, COTA

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5202007029 Issued in MI

Practice address

4554 W 48TH St
Fremont, MI 49412-8721

Phone

(231) 924-9295

Fax

(231) 924-9371

NPI assigned

Jan 23, 2012

Last updated

Jan 23, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327276800000",
    "number": "1184995169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4554 W 48TH ST",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494128721",
            "telephone_number": "231-924-9295",
            "fax_number": "231-924-9371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4554 W 48TH ST",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494128721",
            "telephone_number": "231-924-9295",
            "fax_number": "231-924-9371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EIKENBERRY",
        "first_name": "VICKY",
        "middle_name": "LYNN",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-23",
        "last_updated": "2012-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5202007029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Fremont, MI
• Providers in Fremont, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.