Provider Demographics
NPI:1629295860
Name:ERLACHER, KAREN RENEE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:RENEE
Last Name:ERLACHER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 JONESTOWN RD
Mailing Address - Street 2:#311
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4620
Mailing Address - Country:US
Mailing Address - Phone:336-403-1990
Mailing Address - Fax:
Practice Address - Street 1:353 JONESTOWN RD
Practice Address - Street 2:#311
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4620
Practice Address - Country:US
Practice Address - Phone:336-403-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4782224Z00000X
OR991294224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4782OtherPROF LICENSE
OR991294OtherPROF LICENSE