1699037127 NPI number — MISS EMILY RUTH ELLIOTT B.S., LPTA

Table of content: MISS EMILY RUTH ELLIOTT B.S., LPTA (NPI 1699037127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699037127 NPI number — MISS EMILY RUTH ELLIOTT B.S., LPTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLIOTT
Provider First Name:
EMILY
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
B.S., LPTA
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:
1699037127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
378 SCURLOCK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PATRIOT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45658-9327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-339-9559
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
86 COLUMBUS RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45701-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-249-4081
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2012

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: 225200000X , with the licence number:  08204 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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