MEDICARE: MRS. ERIN ELIZABETH GAINES OTR/L

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	4360	AZ

General Provider Information

NPI Number	:	1932335379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERIN ELIZABETH GAINES OTR/L

Provider Business Mailing Address
First Line	:	995 E BASELINE RD
Second Line	:	APT 2056
City	:	TEMPE
State	:	AZ
Zip	:	85283-1333
Country	:	US
Telephone Number	:	480-206-0496
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 E WARNER RD
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-1057
Country	:	US
Telephone Number	:	480-963-5800
Fax Number	:

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

Provider Enumeration Date	:	05/29/2009
Last Update Date	:	05/29/2009

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