Provider Demographics
NPI:1336673052
Name:BULLER, ERICA NOELLE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:NOELLE
Last Name:BULLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8051 PARKLAND ST UNIT 306
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4144
Mailing Address - Country:US
Mailing Address - Phone:913-620-6653
Mailing Address - Fax:
Practice Address - Street 1:9900 E ILIFF AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-3462
Practice Address - Country:US
Practice Address - Phone:303-636-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105327225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist