Provider Demographics
NPI:1508154022
Name:DUPUIS, ERIN BEAVERS (OT)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:BEAVERS
Last Name:DUPUIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 NE HAZEL DELL AVE
Mailing Address - Street 2:#432
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3803
Mailing Address - Country:US
Mailing Address - Phone:360-624-2553
Mailing Address - Fax:
Practice Address - Street 1:5825 NW RAY CIR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124
Practice Address - Country:US
Practice Address - Phone:503-601-2954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60232337225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR33383052OtherKAISER
OR1508154022Medicaid