Provider Demographics
NPI:1518357912
Name:CLOUTIER, ERIN (LATC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:CLOUTIER
Suffix:
Gender:F
Credentials:LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 WILBRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01119-2612
Mailing Address - Country:US
Mailing Address - Phone:413-782-1610
Mailing Address - Fax:413-782-1508
Practice Address - Street 1:1215 WILBRAHAM RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01119-2612
Practice Address - Country:US
Practice Address - Phone:413-782-1610
Practice Address - Fax:413-782-1508
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer