Provider Demographics
NPI:1417300906
Name:MCAVOY, ERIN (COTA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MCAVOY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 778
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:AK
Mailing Address - Zip Code:99827-0778
Mailing Address - Country:US
Mailing Address - Phone:907-314-0808
Mailing Address - Fax:907-766-2104
Practice Address - Street 1:9109 MENDENHALL MALL RD STE 7
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7136
Practice Address - Country:US
Practice Address - Phone:907-314-0808
Practice Address - Fax:907-766-2104
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2022-06-15
Deactivation Date:2022-05-03
Deactivation Code:
Reactivation Date:2022-06-08
Provider Licenses
StateLicense IDTaxonomies
OR106S00000X
AK1639743370224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician