Provider Demographics
NPI:1063687168
Name:PICKENS, ELAINE K (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:K
Last Name:PICKENS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N ALGONQUIN AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-2033
Mailing Address - Country:US
Mailing Address - Phone:614-279-0690
Mailing Address - Fax:
Practice Address - Street 1:170 MILL ST
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3036
Practice Address - Country:US
Practice Address - Phone:614-414-5437
Practice Address - Fax:614-414-0280
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH391174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist