Provider Demographics
NPI:1992022982
Name:FULLER, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:FULLER
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 7
Mailing Address - Street 2:
Mailing Address - City:CONCORDVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19331-0007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:847 WASHINGTON ST
Practice Address - Street 2:APT 2
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1548
Practice Address - Country:US
Practice Address - Phone:800-578-7906
Practice Address - Fax:800-878-5497
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9569225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist