Provider Demographics
NPI:1225192537
Name:KEY, ERIKA LYNNE (OTRL)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:LYNNE
Last Name:KEY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MRS
Other - First Name:ERIKA
Other - Middle Name:LYNNE
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:241 SWALLOW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-8695
Mailing Address - Country:US
Mailing Address - Phone:803-441-0149
Mailing Address - Fax:
Practice Address - Street 1:241 SWALLOW LAKE DR
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-8695
Practice Address - Country:US
Practice Address - Phone:803-441-0149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004143225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7288267108Medicaid