Provider Demographics
NPI:1811478860
Name:NELSON, ERICA LEIGH (OTR/L, MS)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LEIGH
Last Name:NELSON
Suffix:
Gender:F
Credentials:OTR/L, MS
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LEIGH
Other - Last Name:BOSCARINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L, MS
Mailing Address - Street 1:50 INDIAN DR
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2579
Mailing Address - Country:US
Mailing Address - Phone:695-507-5654
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:50 INDIAN DR
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2579
Practice Address - Country:US
Practice Address - Phone:695-507-5654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0113624225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist