Provider Demographics
NPI:1881299865
Name:SEAL, ERICA RENEE
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:RENEE
Last Name:SEAL
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 1:1070 PARK LN APT D
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3421
Mailing Address - Country:US
Mailing Address - Phone:859-815-0747
Mailing Address - Fax:
Practice Address - Street 1:4769 WHITESBURG DR SE STE 202
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1684
Practice Address - Country:US
Practice Address - Phone:256-666-0477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5322225X00000X
OHOT009962225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist