Basic Information
Provider Information
NPI: 1750654786
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TABLER
FirstName: ERIN
MiddleName: RACHEL
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8800 SE SUNNYSIDE RD
Address2: STE. 300-N
City: CLACKAMAS
State: OR
PostalCode: 970155738
CountryCode: US
TelephoneNumber: 5036595115
FaxNumber:  
Practice Location
Address1: 11089 E MISSISSIPPI AVE
Address2:  
City: AURORA
State: CO
PostalCode: 800123104
CountryCode: US
TelephoneNumber: 3033441744
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/22/2012
LastUpdateDate: 02/22/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
237700000X  Y Speech, Language and Hearing Service ProvidersHearing Instrument Specialist 

No ID Information.


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