Healthcare Provider Details

I. General information

NPI: 1275437766
Provider Name (Legal Business Name): TYLER ERICA PETERKIN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8133 ARDREY KELL RD STE 104
CHARLOTTE NC
28277-5723
US

IV. Provider business mailing address

136 N 3RD ST APT 1
ALBEMARLE NC
28001-4952
US

V. Phone/Fax

Practice location:
  • Phone: 704-413-0968
  • Fax:
Mailing address:
  • Phone: 845-476-6718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18725
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: