Provider Demographics
NPI:1134665292
Name:MOTT, ERIKA SUE (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:SUE
Last Name:MOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:SUE
Other - Last Name:KEENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4829 FLOSSMOOR PL
Mailing Address - Street 2:APT 205
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-6100
Mailing Address - Country:US
Mailing Address - Phone:616-745-3402
Mailing Address - Fax:
Practice Address - Street 1:4535 DRESSLER RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2545
Practice Address - Country:US
Practice Address - Phone:800-828-0898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical