1962667998 NPI number — MRS. ELIZABETH JANE CUNNINGHAM OTR/L

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962667998 NPI number — MRS. ELIZABETH JANE CUNNINGHAM OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
ELIZABETH
Provider Middle Name:
JANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962667998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
517 ATWOOD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40217-1846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-636-2862
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7823 OLD STATE ROAD 60
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELLERSBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47172-1858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-246-4272
Provider Business Practice Location Address Fax Number:
812-246-8136
Provider Enumeration Date:
07/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  31003874A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 31003874A . This is a "OCCUPATIONAL THERAPIST CERTIFICATION" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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