Provider Demographics
NPI:1528666534
Name:BEARE, ERICA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BEARE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 11TH AVE NW APT 2
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-1943
Mailing Address - Country:US
Mailing Address - Phone:605-216-4110
Mailing Address - Fax:
Practice Address - Street 1:414 S 10TH ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-3856
Practice Address - Country:US
Practice Address - Phone:605-725-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1174225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist