Provider Demographics
NPI:1063173409
Name:BLACKMON, ERIN STOWE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:STOWE
Last Name:BLACKMON
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 1:321 PISGAH CHURCH RD APT 1H
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2854
Mailing Address - Country:US
Mailing Address - Phone:252-943-5232
Mailing Address - Fax:
Practice Address - Street 1:205 E KINGS HWY
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5239
Practice Address - Country:US
Practice Address - Phone:336-623-9712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14595225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist