Provider Demographics
NPI:1689206021
Name:CLEGG, ERIN NICOLE
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:CLEGG
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 1:32 UNDERHILL RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12529-5046
Mailing Address - Country:US
Mailing Address - Phone:518-929-4599
Mailing Address - Fax:
Practice Address - Street 1:32 UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NY
Practice Address - Zip Code:12529-5046
Practice Address - Country:US
Practice Address - Phone:518-929-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023758-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist