Provider Demographics
NPI:1346466604
Name:ELLIOTT, JOHN ANDERSON (OTR)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDERSON
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 JILLIAN WAY
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-4231
Mailing Address - Country:US
Mailing Address - Phone:508-636-7421
Mailing Address - Fax:
Practice Address - Street 1:455 BRAYTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-2642
Practice Address - Country:US
Practice Address - Phone:508-636-7421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6026225X00000X
RIOT00706225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist