Provider Demographics
NPI:1467635870
Name:EDILLO, ERICA L (MA,OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:L
Last Name:EDILLO
Suffix:
Gender:F
Credentials:MA,OTR/L
Other - Prefix:MISS
Other - First Name:ERICA
Other - Middle Name:L
Other - Last Name:SIELAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3519
Mailing Address - Country:US
Mailing Address - Phone:503-263-8903
Mailing Address - Fax:503-266-8632
Practice Address - Street 1:5289 NE ELAM YOUNG PKWY STE 140
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7551
Practice Address - Country:US
Practice Address - Phone:503-747-5359
Practice Address - Fax:503-266-8632
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1072423225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist