Provider Demographics
NPI:1467721209
Name:FONVILLE, ERIN L (MSOT, CPAM, OTR/L)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:L
Last Name:FONVILLE
Suffix:
Gender:F
Credentials:MSOT, CPAM, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2986 KATE BOND RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4003
Mailing Address - Country:US
Mailing Address - Phone:901-820-7430
Mailing Address - Fax:901-820-7431
Practice Address - Street 1:2986 KATE BOND RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4003
Practice Address - Country:US
Practice Address - Phone:901-820-7430
Practice Address - Fax:901-820-7431
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4583225X00000X
IL056.009058225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist