Provider Demographics
NPI:1427665843
Name:QUARLES, ERICA MARIE (MED, LPATA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:MARIE
Last Name:QUARLES
Suffix:
Gender:F
Credentials:MED, LPATA
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:MARIE
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9520 INDIAN PIPE LN
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-7006
Mailing Address - Country:US
Mailing Address - Phone:502-418-5849
Mailing Address - Fax:
Practice Address - Street 1:9520 INDIAN PIPE LN
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-7006
Practice Address - Country:US
Practice Address - Phone:502-418-5849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY266152221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist