Provider Demographics
NPI:1417487927
Name:FULLERTON KELLY, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:FULLERTON KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CAMBRIDGE ST APT 109
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8195
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 CORPORATE CENTER CURV STE 200
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1372
Practice Address - Country:US
Practice Address - Phone:651-968-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-16
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist