Provider Demographics
NPI:1407461395
Name:FONTAINE, ERIN LEE (COTA/L)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LEE
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOOTHBY THERAPY SERVICES
Mailing Address - Street 2:806 NORTH MAIN STREET
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246
Mailing Address - Country:US
Mailing Address - Phone:603-524-9090
Mailing Address - Fax:603-524-1497
Practice Address - Street 1:REEDS FERRY ELEMENTARY SCHOOL
Practice Address - Street 2:15 LYONS ROAD
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054
Practice Address - Country:US
Practice Address - Phone:603-424-6215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0208224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant