Provider Demographics
NPI:1861041816
Name:PARK, ERIN (OTR)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 PECOS CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-2900
Mailing Address - Country:US
Mailing Address - Phone:469-971-3830
Mailing Address - Fax:
Practice Address - Street 1:9300 JOHN HICKMAN PKWY STE 104
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5936
Practice Address - Country:US
Practice Address - Phone:469-971-3830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119893225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist