Provider Demographics
NPI:1427535277
Name:ALLEN, ERICA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 JACKIE LN
Mailing Address - Street 2:
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-1123
Mailing Address - Country:US
Mailing Address - Phone:774-271-0366
Mailing Address - Fax:
Practice Address - Street 1:4 JACKIE LN
Practice Address - Street 2:
Practice Address - City:MATTAPOISETT
Practice Address - State:MA
Practice Address - Zip Code:02739-1123
Practice Address - Country:US
Practice Address - Phone:774-271-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11199225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11199OtherOCCUPATIONAL THERAPY LICENSE