Provider Demographics
NPI:1083021612
Name:STEMPLE, ERICKA L (COTA/L)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:L
Last Name:STEMPLE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MAZON AVE
Mailing Address - Street 2:
Mailing Address - City:DWIGHT
Mailing Address - State:IL
Mailing Address - Zip Code:60420-1104
Mailing Address - Country:US
Mailing Address - Phone:815-584-9268
Mailing Address - Fax:815-584-9268
Practice Address - Street 1:300 E MAZON AVE
Practice Address - Street 2:
Practice Address - City:DWIGHT
Practice Address - State:IL
Practice Address - Zip Code:60420-1104
Practice Address - Country:US
Practice Address - Phone:815-584-9268
Practice Address - Fax:815-584-9268
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.002632224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant