Provider Demographics
NPI:1477654275
Name:ZIMMERMAN, ELIZABETH ANNA (MSOTR)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNA
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MSOTR
Other - Prefix:MRS
Other - First Name:LOLLIE
Other - Middle Name:ANNA
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSOTR
Mailing Address - Street 1:3657 BLUEBERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8885
Mailing Address - Country:US
Mailing Address - Phone:530-677-5492
Mailing Address - Fax:530-677-5492
Practice Address - Street 1:3657 BLUEBERRY HILL DR
Practice Address - Street 2:
Practice Address - City:SHINGLE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95682-8885
Practice Address - Country:US
Practice Address - Phone:530-677-5492
Practice Address - Fax:530-677-5492
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 4110225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17413ZMedicare ID - Type Unspecified