Provider Demographics
NPI:1497466866
Name:PENCE, ELIZABETH HANSINGER (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HANSINGER
Last Name:PENCE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 SAINT CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4312
Mailing Address - Country:US
Mailing Address - Phone:216-308-1642
Mailing Address - Fax:
Practice Address - Street 1:1619 SAINT CHARLES AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4312
Practice Address - Country:US
Practice Address - Phone:216-308-1642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT003817225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation