Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 5044 | AZ |
NPI | 1861883662 |
---|---|
Provider Name | Elizabeth Elgin |
First Address | Lakeside, AZ 85929-5209 |
Second Address | Lakeside, AZ 85929-5209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2015 |
Last Update Date | 15/02/2015 |