Healthcare Provider Details

I. General information

NPI: 1952706491
Provider Name (Legal Business Name): ERIN ST. GEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN LEONARD

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-1552
US

IV. Provider business mailing address

800 WASHINGTON ST BOX 419
BOSTON MA
02111-1552
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2100
  • Fax:
Mailing address:
  • Phone: 617-636-5632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10517
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: