MEDICARE: ERIN LEE SYKORA OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XM0800X	Mental Health Occupational Therapist

General Provider Information

NPI Number	:	1033555420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN LEE SYKORA OT

Provider Business Mailing Address
First Line	:	1820 WALNUT ST E
Second Line	:	SUITE #7
City	:	DEVILS LAKE
State	:	ND
Zip	:	58301-3411
Country	:	US
Telephone Number	:	701-665-2140
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 WALNUT ST E
Second Line	:	SUITE #7
City	:	DEVILS LAKE
State	:	ND
Zip	:	58301-3411
Country	:	US
Telephone Number	:	701-665-2140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2013
Last Update Date	:	05/13/2013

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