Provider Demographics
NPI:1720373194
Name:ERICKSON, JOANNE MARIE (COTA)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:MARIE
Last Name:ERICKSON
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 1:7841 TALBERT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8424
Mailing Address - Country:US
Mailing Address - Phone:310-339-6858
Mailing Address - Fax:
Practice Address - Street 1:7841 TALBERT ST APT 1
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-8424
Practice Address - Country:US
Practice Address - Phone:310-339-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1250224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant