Provider Demographics
NPI:1841556834
Name:DAMIANO, ERICA CHRISTINE (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:CHRISTINE
Last Name:DAMIANO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-3052
Mailing Address - Country:US
Mailing Address - Phone:508-586-5977
Mailing Address - Fax:
Practice Address - Street 1:801 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3052
Practice Address - Country:US
Practice Address - Phone:508-586-5977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOTA00571174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist