MEDICARE: ERYIA SHANISE IRVING OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1144926007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERYIA SHANISE IRVING OT

Provider Business Mailing Address
First Line	:	14540 ENGLISH PARK CIR UNIT 104
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-6473
Country	:	US
Telephone Number	:	618-975-4594
Fax Number	:

Provider Business Practice Location Address
First Line	:	5850 E LOVERS LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-2902
Country	:	US
Telephone Number	:	618-975-4594
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2023
Last Update Date	:	02/02/2023

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Directions to “ ERYIA SHANISE IRVING OT” Practice Location

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