Provider Demographics
NPI:1932719416
Name:JORDAN, ERYN CASEY (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ERYN
Middle Name:CASEY
Last Name:JORDAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8940 VERMILLION ST APT 9309
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-1626
Mailing Address - Country:US
Mailing Address - Phone:214-934-6416
Mailing Address - Fax:
Practice Address - Street 1:621 HIGHLANDER AVE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-3525
Practice Address - Country:US
Practice Address - Phone:214-432-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5360225X00000X
TX121064225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist