Provider Demographics
NPI:1376750554
Name:ERBIS, JESSICA LYNN (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:ERBIS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:BEAUDOIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:132 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2808
Mailing Address - Country:US
Mailing Address - Phone:203-250-9663
Mailing Address - Fax:203-699-9641
Practice Address - Street 1:132 ELM ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2808
Practice Address - Country:US
Practice Address - Phone:203-250-9663
Practice Address - Fax:203-699-9641
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002758225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT130002758CT01OtherBCBS
CT0100901OtherAETNA ORTHONET
CT754954OtherCONNECTICARE
CT64-04292OtherUNITED HEALTHCARE
CT9044356OtherAETNA
CT3672389002OtherCIGNA
CT0012701OtherCIGNA ORTHONET