Individual
ERICA ELLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 BODIN CIR, TRAVIS AFB, CA 94535-1809
(707) 423-7899
Mailing address
101 BODIN CIR, TRAVIS AFB, CA 94535-1809
(707) 423-7899
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
1066779
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274802
—
OR
Enumeration date
01/12/2007
Last updated
07/24/2019
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