Provider Demographics
NPI:1972761393
Name:MOTTONEN, ERIN LYDON (PTA)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:LYDON
Last Name:MOTTONEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:KELLOGG
Mailing Address - State:ID
Mailing Address - Zip Code:83837-2004
Mailing Address - Country:US
Mailing Address - Phone:208-784-1283
Mailing Address - Fax:208-784-0151
Practice Address - Street 1:601 W CAMERON AVE
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837-2004
Practice Address - Country:US
Practice Address - Phone:208-784-1283
Practice Address - Fax:208-784-0151
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPTA 416225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant