Provider Demographics
NPI:1518038710
Name:WHITNEY, ERICA HAZEL (OTRL, CHT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:HAZEL
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:OTRL, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 E CACTUS WREN DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-6289
Mailing Address - Country:US
Mailing Address - Phone:520-208-3087
Mailing Address - Fax:
Practice Address - Street 1:453 E CACTUS WREN DR
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-6289
Practice Address - Country:US
Practice Address - Phone:520-208-3087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2018-10-17
Deactivation Date:2013-05-21
Deactivation Code:
Reactivation Date:2018-10-17
Provider Licenses
StateLicense IDTaxonomies
NM1861225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist