Basic Information
| Provider Information | |||||||||
| NPI: | 1770076085 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERNAT | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | CLAIRE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 126 W IOWA ST | ||||||||
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| City: | SPRING VALLEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613621937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153038571 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4515 SUNNYSIDE RD SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973023954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033708284 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2018 | ||||||||
| LastUpdateDate: | 06/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.