Provider Demographics
NPI:1629262753
Name:INGERSOLL, ERIN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:INGERSOLL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:GIEBNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:6354 SHAKER TRACT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROSE
Mailing Address - State:NY
Mailing Address - Zip Code:14516-9509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:131 DRUMLIN CT
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1863
Practice Address - Country:US
Practice Address - Phone:315-332-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00398600174400000X
NY011406-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist