Provider Demographics
NPI:1639281249
Name:ERICKSON, ANNA J (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:J
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:J
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:745 N. WOOD ST.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622
Mailing Address - Country:US
Mailing Address - Phone:773-419-9491
Mailing Address - Fax:312-455-9893
Practice Address - Street 1:745 N. WOOD ST.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:773-419-9491
Practice Address - Fax:312-455-9893
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-004291225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK22282Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPY