Provider Demographics
NPI:1184093510
Name:TOHTZ, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:TOHTZ
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 1:1705 HEATHERIDGE RD
Mailing Address - Street 2:E 106
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5662
Mailing Address - Country:US
Mailing Address - Phone:651-792-6299
Mailing Address - Fax:
Practice Address - Street 1:903 S GREELEY HWY
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-3057
Practice Address - Country:US
Practice Address - Phone:307-634-2109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-1162LP225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist