Provider Demographics
NPI:1699178632
Name:RIDLEY-MORRIS, ELIZABGETH (O TL)
Entity Type:Individual
Prefix:
First Name:ELIZABGETH
Middle Name:
Last Name:RIDLEY-MORRIS
Suffix:
Gender:F
Credentials:O TL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 LILY GREEN COURT.
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027
Mailing Address - Country:US
Mailing Address - Phone:516-312-5860
Mailing Address - Fax:
Practice Address - Street 1:1005 LILY GREEN CT NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3398
Practice Address - Country:US
Practice Address - Phone:516-312-5860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-05
Last Update Date:2014-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9435225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist