Provider Demographics
NPI:1861795304
Name:LANPHERE, ERIC CESSNA (OTR/L)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:CESSNA
Last Name:LANPHERE
Suffix:
Gender:M
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 1:173 EL CAMINO CAMPO
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-7518
Mailing Address - Country:US
Mailing Address - Phone:505-890-4117
Mailing Address - Fax:505-890-8345
Practice Address - Street 1:173 EL CAMINO CAMPO
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-7518
Practice Address - Country:US
Practice Address - Phone:505-890-4117
Practice Address - Fax:505-890-8345
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1933225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist