Provider Demographics
NPI:1972581726
Name:HICKS, ERIC (MS OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:HICKS
Suffix:
Gender:M
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 SW 75TH ST
Mailing Address - Street 2:1301
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6636
Mailing Address - Country:US
Mailing Address - Phone:352-246-9578
Mailing Address - Fax:
Practice Address - Street 1:2625 SW 75TH ST
Practice Address - Street 2:1301
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6636
Practice Address - Country:US
Practice Address - Phone:352-246-9578
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 11044225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ099YOtherOUT OF NETWORK THERAPIST
FLU4687ZMedicare ID - Type UnspecifiedOT IN PRIVATE PRACTICE