Provider Demographics
NPI:1891093308
Name:TYRE, ERIN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:TYRE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:ECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:861074 WORTHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-3426
Mailing Address - Country:US
Mailing Address - Phone:706-525-8210
Mailing Address - Fax:
Practice Address - Street 1:861074 WORTHINGTON DR
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-3426
Practice Address - Country:US
Practice Address - Phone:706-525-8210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16761225XP0200X
GAOT005227225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014464000Medicaid