Provider Demographics
NPI:1386717577
Name:MARTIN, ERIN L (OTR)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:L
Other - Last Name:SHERIDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:4411 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-5349
Mailing Address - Country:US
Mailing Address - Phone:765-674-4455
Mailing Address - Fax:765-674-3577
Practice Address - Street 1:4411 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-5349
Practice Address - Country:US
Practice Address - Phone:765-674-4455
Practice Address - Fax:765-674-3577
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003878A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN129137500OtherUS DEPARTMENT OF LABOR
IN100124000Medicaid
IN156540Medicare PIN
IN0934170001Medicare NSC