Provider Demographics
NPI:1871139212
Name:ORTTEL, ERIN L (MAT, LAT, ATC, M1)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:L
Last Name:ORTTEL
Suffix:
Gender:F
Credentials:MAT, LAT, ATC, M1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 WEST 1350 SOUTH COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:IN
Mailing Address - Zip Code:46932
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:570 E 900 N
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:IN
Practice Address - Zip Code:46926
Practice Address - Country:US
Practice Address - Phone:765-985-2931
Practice Address - Fax:765-985-2056
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer