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NPI Code Detail

MEDICARE: ERIN PENDLETON

MEDICARE: ERIN PENDLETON
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1649501578
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN PENDLETON
Provider Business Mailing Address
First Line : 2104 LEWIS TURNER BLVD
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32547-1316
Country : US
Telephone Number : 850-862-3727
Fax Number : 850-862-6270
Provider Business Practice Location Address
First Line : 2104 LEWIS TURNER BLVD
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32547-1316
Country : US
Telephone Number : 850-862-3727
Fax Number : 850-862-6270
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2010
Last Update Date : 01/15/2010

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