Provider Demographics
NPI:1881942373
Name:CANNELLA, ERIN E (MS OT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:CANNELLA
Suffix:
Gender:F
Credentials:MS OT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:E
Other - Last Name:BRUTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:500 MCHENRY RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1705
Practice Address - Country:US
Practice Address - Phone:847-537-3445
Practice Address - Fax:847-537-3445
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.009204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist