Healthcare Provider Details

I. General information

NPI: 1700048758
Provider Name (Legal Business Name): ERIN TERRACINA DAGATE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 RIDGEFIELD RD STE C
THIBODAUX LA
70301-4399
US

IV. Provider business mailing address

1713 RIDGEFIELD RD STE C
THIBODAUX LA
70301-4399
US

V. Phone/Fax

Practice location:
  • Phone: 985-449-0944
  • Fax: 985-449-0945
Mailing address:
  • Phone: 985-449-0944
  • Fax: 985-449-0945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTT 200244
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: