Provider Demographics
NPI:1134793235
Name:HISLOP, ERIN AUDREY
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:AUDREY
Last Name:HISLOP
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 1:51649 124TH ST
Mailing Address - Street 2:
Mailing Address - City:AMBOY
Mailing Address - State:MN
Mailing Address - Zip Code:56010-5036
Mailing Address - Country:US
Mailing Address - Phone:507-340-2233
Mailing Address - Fax:
Practice Address - Street 1:1861 EAGLE VIEW CIR
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-1818
Practice Address - Country:US
Practice Address - Phone:507-373-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
MN106597225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist