Provider Demographics
NPI:1073672564
Name:REID, ERICA D (OT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:D
Last Name:REID
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 S SAN VICENTE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4622
Mailing Address - Country:US
Mailing Address - Phone:323-655-8528
Mailing Address - Fax:323-544-0045
Practice Address - Street 1:7864 WILLOUGHBY AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-7225
Practice Address - Country:US
Practice Address - Phone:323-655-8528
Practice Address - Fax:323-544-0045
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT19100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT1910Medicare PIN