Provider Demographics
NPI:1457509499
Name:JASPER, ELIZABETH AUSTIN (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:AUSTIN
Last Name:JASPER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 VERDANT CT
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3407
Mailing Address - Country:US
Mailing Address - Phone:919-217-5561
Mailing Address - Fax:
Practice Address - Street 1:615 SPRING FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-9150
Practice Address - Country:US
Practice Address - Phone:919-981-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5266225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist