Provider Demographics
NPI:1073067922
Name:TEX, ERIKA (COTA)
Entity Type:Individual
Prefix:MISS
First Name:ERIKA
Middle Name:
Last Name:TEX
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 E 775 S
Mailing Address - Street 2:
Mailing Address - City:NINEVEH
Mailing Address - State:IN
Mailing Address - Zip Code:46164-8941
Mailing Address - Country:US
Mailing Address - Phone:317-445-9817
Mailing Address - Fax:
Practice Address - Street 1:56 E 775 S
Practice Address - Street 2:
Practice Address - City:NINEVEH
Practice Address - State:IN
Practice Address - Zip Code:46164-8941
Practice Address - Country:US
Practice Address - Phone:317-445-9817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN348635224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1003238049Medicare PIN