Provider Demographics
NPI:1831875046
Name:CANADA-WEST, ERIN JOANN (LMT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:JOANN
Last Name:CANADA-WEST
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:JOANN
Other - Last Name:CANADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:630 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-6617
Mailing Address - Country:US
Mailing Address - Phone:405-269-9360
Mailing Address - Fax:
Practice Address - Street 1:630 E 14TH ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-6617
Practice Address - Country:US
Practice Address - Phone:405-269-9360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK107502225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist