Provider Demographics
NPI:1508402678
Name:ATKINSON, ELIZABETH CAMPBELL (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CAMPBELL
Last Name:ATKINSON
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 1:1262 BERNITA RD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-8209
Mailing Address - Country:US
Mailing Address - Phone:619-301-1303
Mailing Address - Fax:
Practice Address - Street 1:1262 BERNITA RD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-8209
Practice Address - Country:US
Practice Address - Phone:619-301-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3738225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3738OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAPY