Provider Demographics
NPI:1417002221
Name:MEYER, ERIKA LESLIE (MS, OTR)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:LESLIE
Last Name:MEYER
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 DON JOSE LOOP
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8672
Mailing Address - Country:US
Mailing Address - Phone:505-699-7487
Mailing Address - Fax:
Practice Address - Street 1:54 DON JOSE LOOP
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-8672
Practice Address - Country:US
Practice Address - Phone:505-699-7487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8816174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1618OtherOT LICENSE