Provider Demographics
NPI:1306216031
Name:BAKKE, ERIN (COTA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BAKKE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 VIA SORRENTO
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-5748
Mailing Address - Country:US
Mailing Address - Phone:701-741-5040
Mailing Address - Fax:
Practice Address - Street 1:544 VIA SORRENTO
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5748
Practice Address - Country:US
Practice Address - Phone:701-741-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3297224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant