Provider Demographics
NPI:1649538208
Name:GIMAR, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:GIMAR
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 1:4524 ROCKAWAY LOOP NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4698
Mailing Address - Country:US
Mailing Address - Phone:314-322-7604
Mailing Address - Fax:
Practice Address - Street 1:4524 ROCKAWAY LOOP NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4698
Practice Address - Country:US
Practice Address - Phone:314-322-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1661225X00000X
OR242781225X00000X
CO2179225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist