1780959916 NPI number — MRS. ERICA SUZANNE DEPINET O.T.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780959916 NPI number — MRS. ERICA SUZANNE DEPINET O.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEPINET
Provider First Name:
ERICA
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
O.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAWKINS
Provider Other First Name:
ERICA
Provider Other Middle Name:
SUZANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780959916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 WEST FOURTH ST.
Provider Second Line Business Mailing Address:
SUITE 010
Provider Business Mailing Address City Name:
FOSTERIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-436-8320
Provider Business Mailing Address Fax Number:
419-436-8325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 WEST FOURTH ST.
Provider Second Line Business Practice Location Address:
SUITE 010
Provider Business Practice Location Address City Name:
FOSTERIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-436-8320
Provider Business Practice Location Address Fax Number:
419-436-8325
Provider Enumeration Date:
03/21/2012

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: 225XP0019X , with the licence number:  007720 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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