Healthcare Provider Details

I. General information

NPI: 1134665292
Provider Name (Legal Business Name): ERIKA SUE MOTT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIKA SUE KEENE

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4535 DRESSLER RD NW
CANTON OH
44718-2545
US

IV. Provider business mailing address

4829 FLOSSMOOR PL APT 205
WALDORF MD
20602-6100
US

V. Phone/Fax

Practice location:
  • Phone: 800-828-0898
  • Fax:
Mailing address:
  • Phone: 616-745-3402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: