Basic Information
Provider Information
NPI: 1811381866
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILLIAMS
FirstName: ERIKA
MiddleName: DATUIN
NamePrefix:  
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 15928 VENTURA BLVD STE 218
Address2:  
City: ENCINO
State: CA
PostalCode: 914364413
CountryCode: US
TelephoneNumber: 8185189709
FaxNumber: 7472308320
Practice Location
Address1: 15928 VENTURA BLVD STE 218
Address2:  
City: ENCINO
State: CA
PostalCode: 914364413
CountryCode: US
TelephoneNumber: 8185189709
FaxNumber: 7472308320
Other Information
ProviderEnumerationDate: 03/26/2015
LastUpdateDate: 01/15/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/15/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X15098CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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