Provider Demographics
NPI:1316095037
Name:NUTTALL, ERIN BRAY (ATC, PTA)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:BRAY
Last Name:NUTTALL
Suffix:
Gender:F
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20340 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-9778
Mailing Address - Country:US
Mailing Address - Phone:906-483-3731
Mailing Address - Fax:
Practice Address - Street 1:600 MACINNES DR STE 201
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1144
Practice Address - Country:US
Practice Address - Phone:906-483-1888
Practice Address - Fax:906-483-1881
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer