Provider Demographics
NPI:1710459680
Name:MUIRDEN, ELIZABETH ALICE (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ALICE
Last Name:MUIRDEN
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:511 ELLSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2820
Mailing Address - Country:US
Mailing Address - Phone:203-214-9552
Mailing Address - Fax:
Practice Address - Street 1:292 THORPE AVE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-8309
Practice Address - Country:US
Practice Address - Phone:203-214-9552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001086225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist