Healthcare Provider Details

I. General information

NPI: 1609575497
Provider Name (Legal Business Name): EILEEN ERWIN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22780 THREE NOTCH RD
LEXINGTON PARK MD
20653-1538
US

IV. Provider business mailing address

22153 LONG BOW DR
CALIFORNIA MD
20619-2244
US

V. Phone/Fax

Practice location:
  • Phone: 301-737-0662
  • Fax:
Mailing address:
  • Phone: 865-335-1562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM05950
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: