Provider Demographics
NPI:1497955702
Name:MENGES, ELIZABETH E (OTR)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:MENGES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:MENGES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:7230 OLCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46323-2044
Mailing Address - Country:US
Mailing Address - Phone:219-844-7505
Mailing Address - Fax:
Practice Address - Street 1:6040 LUTE RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5008
Practice Address - Country:US
Practice Address - Phone:219-763-6858
Practice Address - Fax:219-763-4858
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000386A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN31000386AOtherOTR