Provider Demographics
NPI:1780473165
Name:MORIARTY, ERIN KATHLEEN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:KATHLEEN
Last Name:MORIARTY
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 1:16862 S MEADOWCREST DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8418
Mailing Address - Country:US
Mailing Address - Phone:708-860-3632
Mailing Address - Fax:
Practice Address - Street 1:16862 S MEADOWCREST DR
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8418
Practice Address - Country:US
Practice Address - Phone:708-860-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.016172225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist