Basic Information
| Provider Information | |||||||||
| NPI: | 1780959916 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEPINET | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | SUZANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.T. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HAWKINS | ||||||||
| OtherFirstName: | ERICA | ||||||||
| OtherMiddleName: | SUZANNE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | O.T. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 455 WEST FOURTH ST. | ||||||||
| Address2: | SUITE 010 | ||||||||
| City: | FOSTERIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194368320 | ||||||||
| FaxNumber: | 4194368325 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 WEST FOURTH ST. | ||||||||
| Address2: | SUITE 010 | ||||||||
| City: | FOSTERIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194368320 | ||||||||
| FaxNumber: | 4194368325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2012 | ||||||||
| LastUpdateDate: | 04/14/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0019X | 007720 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No ID Information.