Provider Demographics
NPI:1164701801
Name:ANDERSON, ERIN ADRIANNE (CTRS)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:ADRIANNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31296 SPRINGLAKE BLVD
Mailing Address - Street 2:APT 1208
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1136
Mailing Address - Country:US
Mailing Address - Phone:231-492-4366
Mailing Address - Fax:
Practice Address - Street 1:31296 SPRINGLAKE BLVD
Practice Address - Street 2:APT 1208
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1136
Practice Address - Country:US
Practice Address - Phone:231-492-4366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI57716225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist