Provider Demographics
NPI:1982002507
Name:STARK, ERIN E
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:STARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1083
Mailing Address - Street 2:
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80498-1083
Mailing Address - Country:US
Mailing Address - Phone:719-838-3915
Mailing Address - Fax:
Practice Address - Street 1:105 JANES WAY
Practice Address - Street 2:
Practice Address - City:SILVERTHORNE
Practice Address - State:CO
Practice Address - Zip Code:80498
Practice Address - Country:US
Practice Address - Phone:719-838-3915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-13
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0004604225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist