Provider Demographics
NPI:1134473788
Name:SNYDER, ERIN (COTA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:SNYDER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:SHETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10590 SE 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-6385
Mailing Address - Country:US
Mailing Address - Phone:386-283-3344
Mailing Address - Fax:
Practice Address - Street 1:12029 COUNTY ROAD 103
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:FL
Practice Address - Zip Code:34484-2938
Practice Address - Country:US
Practice Address - Phone:352-571-5978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12539224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTA12539OtherSTATE LICENSE