Provider Demographics
NPI:1629038344
Name:D'ELIA, ELIZABETH ELLEN (MED, ATC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ELLEN
Last Name:D'ELIA
Suffix:
Gender:F
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N UNION ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3741
Mailing Address - Country:US
Mailing Address - Phone:802-862-1821
Mailing Address - Fax:
Practice Address - Street 1:SAINT MICHAEL'S COLLEGE
Practice Address - Street 2:ONE WINOOSKI PARK, BOX258
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05439-0001
Practice Address - Country:US
Practice Address - Phone:802-654-2496
Practice Address - Fax:802-654-2497
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104-00000292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer