Provider Demographics
NPI:1376878504
Name:CARPENTER, ELIZABETH MCFARLANE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:MCFARLANE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:812 1/2 E OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-5430
Mailing Address - Country:US
Mailing Address - Phone:309-261-0269
Mailing Address - Fax:309-807-5053
Practice Address - Street 1:812 1/2 E OLIVE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-5430
Practice Address - Country:US
Practice Address - Phone:309-261-0269
Practice Address - Fax:309-807-5053
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056002789225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist