Provider Demographics
NPI:1205625761
Name:RUDDICK, ERYN RENEE
Entity type:Individual
Prefix:
First Name:ERYN
Middle Name:RENEE
Last Name:RUDDICK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3026 HILLCREST DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-7006
Mailing Address - Country:US
Mailing Address - Phone:210-793-0877
Mailing Address - Fax:210-568-4046
Practice Address - Street 1:3026 HILLCREST DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-7006
Practice Address - Country:US
Practice Address - Phone:210-793-0877
Practice Address - Fax:210-568-4046
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124688225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist