Provider Demographics
NPI:1164409611
Name:WRIGHT, ELIZABETH ANNE (OT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:E ANNE
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:511 JERMOR LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6151
Mailing Address - Country:US
Mailing Address - Phone:410-876-8076
Mailing Address - Fax:410-876-3818
Practice Address - Street 1:511 JERMOR LN
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6151
Practice Address - Country:US
Practice Address - Phone:410-876-8076
Practice Address - Fax:410-876-3818
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04305225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7914198OtherAETNA
2160584OtherACN
2160584OtherUNITED HEALTHCARE
615121-03OtherBLUECROSS OF MARYLAND
T208OtherBLUECHOICE/GHMSI
2160584OtherUNITED HEALTHCARE
969LE587Medicare ID - Type Unspecified