Active NPI
Calvin John Eggenberger, OTR/L
- Occupational Therapist
- Normal, IL
National Provider Identifier
1871103010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056.013673
- Practice address
- 1200 E College Ave
Normal, IL 61761-3100 - Phone
- (309) 533-7673
- NPI assigned
- Aug 3, 2020
- Sex
- Male
- 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 | 056.013673 | IL | Primary |
Addresses
Primary practice location
1200 E College Ave
Normal, IL 61761-3100
Mailing address
1822 Glenbridge Rd
Bloomington, IL 61704-8769
Phone (619) 735-6105
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056.013673 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596499200000",
"number": "1871103010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1822 GLENBRIDGE RD",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617048769",
"telephone_number": "619-735-6105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 E COLLEGE AVE",
"city": "NORMAL",
"state": "IL",
"postal_code": "617613100",
"telephone_number": "309-533-7673"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EGGENBERGER",
"first_name": "CALVIN",
"middle_name": "JOHN",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-03",
"last_updated": "2020-08-04",
"certification_date": "2020-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056.013673",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Normal, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.