Provider Demographics
NPI:1073003182
Name:QUILLMAN, ERIN MICHELLE (LMT, CLT, COTA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MICHELLE
Last Name:QUILLMAN
Suffix:
Gender:F
Credentials:LMT, CLT, COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 DARNELL ST
Mailing Address - Street 2:
Mailing Address - City:WOLVERINE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-1846
Mailing Address - Country:US
Mailing Address - Phone:248-568-2113
Mailing Address - Fax:
Practice Address - Street 1:2300 DARNELL ST
Practice Address - Street 2:
Practice Address - City:WOLVERINE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-1846
Practice Address - Country:US
Practice Address - Phone:248-568-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202005188224Z00000X
MI7501006602225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant