Provider Demographics
NPI:1295045482
Name:OPPEWALL, ELIZABETH S (RPT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:S
Last Name:OPPEWALL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 761
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04679-0761
Mailing Address - Country:US
Mailing Address - Phone:207-244-9048
Mailing Address - Fax:
Practice Address - Street 1:29 RIDGE ACRES LN
Practice Address - Street 2:
Practice Address - City:SOUTHWEST HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04679-4239
Practice Address - Country:US
Practice Address - Phone:207-244-9048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME8452251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics