Provider Demographics
NPI:1346376472
Name:JONES, ELIZABETH ANNE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:JONES
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:REDWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:35 MARES HILL RD
Mailing Address - Street 2:
Mailing Address - City:IVORYTON
Mailing Address - State:CT
Mailing Address - Zip Code:06442-1230
Mailing Address - Country:US
Mailing Address - Phone:860-767-1340
Mailing Address - Fax:860-767-1341
Practice Address - Street 1:124 WESTBROOK RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1511
Practice Address - Country:US
Practice Address - Phone:860-767-7587
Practice Address - Fax:860-767-3418
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002091225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT130002091CT01OtherANTHEM BC BS
CT7165764OtherAETNA