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Individual

ERICA MOON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2600 FERRY ST, LAFAYETTE, IN 47904
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31006305A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000001074540
ANTHEM PROVIDER NUMBER
IN
05
300001352
IN
Enumeration date
02/28/2017
Last updated
07/11/2018
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