Provider Demographics
NPI:1346529260
Name:ANDERSON, MERCEDES ERAKA (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MERCEDES
Middle Name:ERAKA
Last Name:ANDERSON
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 1:5607 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3702
Mailing Address - Country:US
Mailing Address - Phone:646-541-1222
Mailing Address - Fax:
Practice Address - Street 1:3801 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-4530
Practice Address - Country:US
Practice Address - Phone:646-541-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06510225X00000X
DCOT010000529225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist