Active NPI
Lynn Eadie, OTR/L
- Occupational Therapist
- Fairfax, VA
National Provider Identifier
1457776973
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 0119001284
- Practice address
- 12625 Dusty Wheel LN
Fairfax, VA 22033-1736 - Phone
- (703) 615-6553
- NPI assigned
- Feb 20, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 | OT 15189 | FL | |
| Occupational Therapist | 225X00000X | 0119001284 | VA | Primary |
Addresses
Primary practice location
12625 Dusty Wheel LN
Fairfax, VA 22033-1736
Mailing address
12625 Dusty Wheel LN
Fairfax, VA 22033-1736
Phone (703) 615-6553
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 |
|---|---|---|---|
| OT 15189 | FL | MD | Occupational Therapist |
| 0119001284 | VA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1392854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392854400000",
"number": "1457776973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12625 DUSTY WHEEL LN",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220331736",
"telephone_number": "703-615-6553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12625 DUSTY WHEEL LN",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220331736",
"telephone_number": "703-615-6553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EADIE",
"first_name": "LYNN",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-02-20",
"last_updated": "2014-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OT 15189",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "VA",
"license": "0119001284",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.