Provider Demographics
NPI:1386800324
Name:SEAGRAVES, ERIN MICHELLE (OTR, NCTMB)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:MICHELLE
Last Name:SEAGRAVES
Suffix:
Gender:F
Credentials:OTR, NCTMB
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:MICHELLE
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8260 FURLONG CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4321
Mailing Address - Country:US
Mailing Address - Phone:317-372-8769
Mailing Address - Fax:
Practice Address - Street 1:7301 E 16TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-2308
Practice Address - Country:US
Practice Address - Phone:317-353-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003855A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist