1134108046 NPI number — MRS. ERIN C MOREAU OT CLT

Table of content: MRS. ERIN C MOREAU OT CLT (NPI 1134108046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134108046 NPI number — MRS. ERIN C MOREAU OT CLT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOREAU
Provider First Name:
ERIN
Provider Middle Name:
C
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OT CLT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROWLEY
Provider Other First Name:
ERIN
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1134108046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1344 N CENTER ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
HICKORY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28601-2796
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-322-7007
Provider Business Mailing Address Fax Number:
828-327-6006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1344 N CENTER ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HICKORY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28601-2796
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-322-7007
Provider Business Practice Location Address Fax Number:
828-327-6006
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  4065 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 806059 . This is a "PARTNERS MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 03245 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 136U5 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7432688 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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