Provider Demographics
NPI:1972776722
Name:KAMIN, ERIN MARIE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:MARIE
Last Name:KAMIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:MARIE
Other - Last Name:O'HARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:N34W23133 CIRCLE RIDGE RD APT 102
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-5732
Mailing Address - Country:US
Mailing Address - Phone:262-613-1467
Mailing Address - Fax:
Practice Address - Street 1:N34W23133 CIRCLE RIDGE RD APT 102
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5732
Practice Address - Country:US
Practice Address - Phone:262-613-1467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1607-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40896900Medicaid