Provider Demographics
NPI:1285004002
Name:BUSTER, ERICA (MS, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:
Last Name:BUSTER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MRS
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:BUSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-2016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 WILSON RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7026
Practice Address - Country:US
Practice Address - Phone:833-272-3743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 16521225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist