Provider Demographics
NPI:1376998989
Name:MIXER, ELIZABETH ANNE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:MIXER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:MANTKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:7591 TYLERS PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-6308
Mailing Address - Country:US
Mailing Address - Phone:513-755-6600
Mailing Address - Fax:513-755-3762
Practice Address - Street 1:7591 TYLERS PLACE BLVD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069
Practice Address - Country:US
Practice Address - Phone:513-755-6600
Practice Address - Fax:513-755-3762
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10238225X00000X
OHOT010181225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7201016Medicaid
OHAB7360731OtherMEDICARE PIN
OH2187155Medicaid
NC0788AOtherBCBS