Provider Demographics
NPI:1447605902
Name:ELDREDGE, ELIZABETH (OT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ELDREDGE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ST PATRICK PL
Mailing Address - Street 2:
Mailing Address - City:PORT HENRY
Mailing Address - State:NY
Mailing Address - Zip Code:12974-1200
Mailing Address - Country:US
Mailing Address - Phone:518-546-7151
Mailing Address - Fax:518-546-3785
Practice Address - Street 1:10 ST PATRICK PL
Practice Address - Street 2:
Practice Address - City:PORT HENRY
Practice Address - State:NY
Practice Address - Zip Code:12974-1200
Practice Address - Country:US
Practice Address - Phone:518-546-7151
Practice Address - Fax:518-546-3785
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist