Provider Demographics
NPI:1265687743
Name:NOONAN, ERICA NOELANI (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:NOELANI
Last Name:NOONAN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SAINT PAULS PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-1938
Mailing Address - Country:US
Mailing Address - Phone:718-681-6227
Mailing Address - Fax:
Practice Address - Street 1:450 SAINT PAULS PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-1938
Practice Address - Country:US
Practice Address - Phone:718-681-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63 016252225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist