Provider Demographics
NPI:1245379700
Name:DOYLE, ERIN RAE (OT)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:RAE
Last Name:DOYLE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:RAE
Other - Last Name:STOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2562 CREVE COEUR DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10560 OLD OLIVE STREET ROAD SUITE 100
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-567-4707
Practice Address - Fax:314-567-4505
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004021960225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507265809Medicaid
MO477198006Medicaid
MO114090792Medicare UPIN
MO507265809Medicaid