Provider Demographics
NPI:1801284757
Name:SHIELDS, ERICKA HANSON (MOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ERICKA
Middle Name:HANSON
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 HAYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3512
Mailing Address - Country:US
Mailing Address - Phone:215-498-8865
Mailing Address - Fax:
Practice Address - Street 1:422 HAYWOOD RD
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-3512
Practice Address - Country:US
Practice Address - Phone:215-498-8865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012004225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist