Provider Demographics
NPI:1063998227
Name:NOLISH, ERIC DAVID (OTR/L)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DAVID
Last Name:NOLISH
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 1:1315 LATHRUP AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-4736
Mailing Address - Country:US
Mailing Address - Phone:989-326-1182
Mailing Address - Fax:
Practice Address - Street 1:3615 E ASHMAN ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-8858
Practice Address - Country:US
Practice Address - Phone:989-837-0895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006268225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist