Provider Demographics
NPI:1861751695
Name:FULLER, ERIN E (OTR/L)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:FULLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BIRNIE AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1107
Mailing Address - Country:US
Mailing Address - Phone:413-781-1054
Mailing Address - Fax:413-526-9960
Practice Address - Street 1:168 DENSLOW RD
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-3188
Practice Address - Country:US
Practice Address - Phone:413-526-9969
Practice Address - Fax:413-526-9960
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8184225X00000X
CT003335225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist