Provider Demographics
NPI:1427354604
Name:PETERS, ERIN ELLEN (MOTR/L)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:ELLEN
Last Name:PETERS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FARRAND HILL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:ME
Mailing Address - Zip Code:04221-3011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 LEARNING LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-7039
Practice Address - Country:US
Practice Address - Phone:207-778-9517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2519225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist