Provider Demographics
NPI:1114326048
Name:ABERNATHY, ELIZABERTH (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABERTH
Middle Name:
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S PALM DR
Mailing Address - Street 2:
Mailing Address - City:WINNABOW
Mailing Address - State:NC
Mailing Address - Zip Code:28479-5187
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:104 S PALM DR
Practice Address - Street 2:
Practice Address - City:WINNABOW
Practice Address - State:NC
Practice Address - Zip Code:28479-5187
Practice Address - Country:US
Practice Address - Phone:910-616-6379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6057225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist