Provider Demographics
NPI:1831113984
Name:MALTBA, ERIN M (OT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:MALTBA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 NICKLAUS LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-3363
Mailing Address - Country:US
Mailing Address - Phone:864-386-8055
Mailing Address - Fax:
Practice Address - Street 1:3620 COVENANT RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4216
Practice Address - Country:US
Practice Address - Phone:803-787-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3052225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12659913OtherCAQH#
SCTH1620Medicaid