Provider Demographics
NPI:1093122160
Name:OLIN, ERICA (LMT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:OLIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:SCOTTS MILLS
Mailing Address - State:OR
Mailing Address - Zip Code:97375
Mailing Address - Country:US
Mailing Address - Phone:503-989-7389
Mailing Address - Fax:
Practice Address - Street 1:4340 COMMERCIAL AT SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:503-989-7389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19677172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker