Basic Information
| Provider Information | |||||||||
| NPI: | 1285160366 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DECKER | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | L | ||||||||
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| OtherLastName: | TRAMBAUGH | ||||||||
| OtherFirstName: | ERIN | ||||||||
| OtherMiddleName: | L | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12062 S POINT DR | ||||||||
| Address2: | |||||||||
| City: | LOOGOOTEE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475535760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122960146 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2701 CHESTNUT STATION CT | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402996395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003351060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2017 | ||||||||
| LastUpdateDate: | 05/10/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 31006047A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.