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General NPI Number Information
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NPI Number | 1053652701
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Entity Type | Individual
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Provider Name | PENELOPE JO ERICKSON MS, OTR, SWC
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Gender | Female
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 1900 E LOS ANGELES AVE
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City | SIMI VALLEY
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State | CA
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Zip | 93065-6560
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Country | US
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Telephone | 805-955-7129
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Fax |
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Provider Business Mailing Address
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Address Line | 13561 ARROYO DALE LN
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City | SAN DIEGO
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State | CA
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Zip | 92130-5789
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 1867
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License Number State | CA
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