Provider Demographics
NPI:1407351026
Name:STAUFFER, ERIN (OTRL)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:LAVANWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55432 COLBY ST
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-8701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55432 COLBY ST
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-8701
Practice Address - Country:US
Practice Address - Phone:269-782-7828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist