Provider Demographics
NPI:1336544329
Name:TUDOR, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:TUDOR
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 1:233 RUCCIO WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3584
Mailing Address - Country:US
Mailing Address - Phone:888-888-8888
Mailing Address - Fax:
Practice Address - Street 1:233 RUCCIO WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3584
Practice Address - Country:US
Practice Address - Phone:859-888-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist