Provider Demographics
NPI:1578845632
Name:BERGHOFF, ELIZABETH ANNE (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:BERGHOFF
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12A HILLVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2394
Mailing Address - Country:US
Mailing Address - Phone:260-446-2916
Mailing Address - Fax:
Practice Address - Street 1:12A HILLVIEW CIR
Practice Address - Street 2:
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-2394
Practice Address - Country:US
Practice Address - Phone:260-446-2916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006791224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant