Provider Demographics
NPI:1225421936
Name:MEDINA, ELIZABETH MAY (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MAY
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MAY
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 24TH AVE NW STE 100
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6389
Mailing Address - Country:US
Mailing Address - Phone:580-402-3373
Mailing Address - Fax:
Practice Address - Street 1:111 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6388
Practice Address - Country:US
Practice Address - Phone:580-402-3373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6090225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist