MEDICARE: KIARA KAYE ERDMANN OTR

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	225X00000X	Occupational Therapist	OT.009360	OH

General Provider Information

NPI Number	:	1881042810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIARA KAYE ERDMANN OTR

Provider Business Mailing Address
First Line	:	153 CHESAPEAKE CT
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-4514
Country	:	US
Telephone Number	:	920-285-6385
Fax Number	:

Provider Business Practice Location Address
First Line	:	16600 W SPRAGUE RD STE 365
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-6319
Country	:	US
Telephone Number	:	216-820-4492
Fax Number	:

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

Provider Enumeration Date	:	05/31/2016
Last Update Date	:	05/31/2016

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