Provider Demographics
NPI:1568005254
Name:COLLARD, ERICA ALEXIS
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ALEXIS
Last Name:COLLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26703 N FAIRWAY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HUFFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:77336-3759
Mailing Address - Country:US
Mailing Address - Phone:281-795-4426
Mailing Address - Fax:
Practice Address - Street 1:1620 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-3546
Practice Address - Country:US
Practice Address - Phone:936-336-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215971224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant