Provider Demographics
NPI:1144926007
Name:IRVING, ERYIA SHANISE (OT)
Entity type:Individual
Prefix:
First Name:ERYIA
Middle Name:SHANISE
Last Name:IRVING
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14540 ENGLISH PARK CIR UNIT 104
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-6473
Mailing Address - Country:US
Mailing Address - Phone:618-975-4594
Mailing Address - Fax:
Practice Address - Street 1:5850 E LOVERS LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-2902
Practice Address - Country:US
Practice Address - Phone:618-975-4594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist