Healthcare Provider Details

I. General information

NPI: 1083045728
Provider Name (Legal Business Name): ERIN STOSICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2013
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1973 MORNINGSIDE RD APT 217
FREMONT NE
68025-8936
US

IV. Provider business mailing address

1000 N WEST AVE STE 210
SIOUX FALLS SD
57104-1314
US

V. Phone/Fax

Practice location:
  • Phone: 402-750-6626
  • Fax:
Mailing address:
  • Phone: 605-231-2490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1663
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: