Provider Demographics
NPI:1093980047
Name:ELMORE, MISTY (OTR/L)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:ELMORE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:450 NEW MARKET BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5501
Mailing Address - Country:US
Mailing Address - Phone:828-355-9584
Mailing Address - Fax:828-355-9689
Practice Address - Street 1:3703 WEST LAKE AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1223
Practice Address - Country:US
Practice Address - Phone:847-998-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007320225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist