Active NPI
Etelka Eickelbeck
- Pediatric Occupational Therapist
- North Salem, NY
National Provider Identifier
1508320912
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 004482
- Practice address
- 69 Lake St
North Salem, NY 10560-1311 - Phone
- (914) 703-2008
- NPI assigned
- Jan 30, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 004482 | NY | Primary |
Addresses
Primary practice location
69 Lake St
North Salem, NY 10560-1311
Mailing address
69 Lake St
North Salem, NY 10560-1311
Phone (914) 703-2008
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548806400000",
"number": "1508320912",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "69 LAKE ST",
"city": "NORTH SALEM",
"state": "NY",
"postal_code": "105601311",
"telephone_number": "914-703-2008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "69 LAKE ST",
"city": "NORTH SALEM",
"state": "NY",
"postal_code": "105601311",
"telephone_number": "914-703-2008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EICKELBECK",
"first_name": "ETELKA",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-30",
"last_updated": "2019-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Occupational Therapist, Pediatrics",
"state": "NY",
"license": "004482",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Salem, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.