Provider Demographics
NPI:1891209482
Name:DENT, ERICA BLACKFORD (COTA/L)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:BLACKFORD
Last Name:DENT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:ANN
Other - Last Name:BLACKFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-3953
Mailing Address - Country:US
Mailing Address - Phone:870-514-9278
Mailing Address - Fax:
Practice Address - Street 1:207 BALFOUR RD
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1701
Practice Address - Country:US
Practice Address - Phone:870-733-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-19
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1288224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant