Provider Demographics
NPI:1528328648
Name:THALL, ERIKA K (MAED)
Entity type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:K
Last Name:THALL
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:MISS
Other - First Name:ERIKA
Other - Middle Name:K
Other - Last Name:SPELLICY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAED
Mailing Address - Street 1:21 POWERS DR
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-4965
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 POWERS DR
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-4965
Practice Address - Country:US
Practice Address - Phone:315-750-8588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator