Provider Demographics
NPI:1275144594
Name:REVETTE, ERYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ERYN
Middle Name:
Last Name:REVETTE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 PIKEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:NY
Mailing Address - Zip Code:12917-1804
Mailing Address - Country:US
Mailing Address - Phone:518-483-9325
Mailing Address - Fax:
Practice Address - Street 1:637 CO RD 1
Practice Address - Street 2:
Practice Address - City:FORT COVINGTON
Practice Address - State:NY
Practice Address - Zip Code:12937
Practice Address - Country:US
Practice Address - Phone:518-358-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024775225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty