Provider Demographics
NPI:1114459633
Name:WOODWORTH, ERIKA
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 A ST
Mailing Address - Street 2:PO BOX 144
Mailing Address - City:NORTH POWDER
Mailing Address - State:OR
Mailing Address - Zip Code:97867-8178
Mailing Address - Country:US
Mailing Address - Phone:435-764-8277
Mailing Address - Fax:
Practice Address - Street 1:495 A ST
Practice Address - Street 2:
Practice Address - City:NORTH POWDER
Practice Address - State:OR
Practice Address - Zip Code:97867-8178
Practice Address - Country:US
Practice Address - Phone:435-764-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer