Provider Demographics
NPI:1225785207
Name:MAHAY, ELIZABETH MARIE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:MAHAY
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 1:6002 SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-2861
Mailing Address - Country:US
Mailing Address - Phone:317-525-8386
Mailing Address - Fax:844-556-4672
Practice Address - Street 1:6002 SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-2861
Practice Address - Country:US
Practice Address - Phone:317-525-8386
Practice Address - Fax:844-556-4672
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007665A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300054649Medicaid