Provider Demographics
NPI:1710935960
Name:RAY, ELIZABETH ANNE (OTR L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:RAY
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:PO BOX 1827
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43301-1827
Mailing Address - Country:US
Mailing Address - Phone:740-383-8022
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:1050 DELAWARE AVENUE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302
Practice Address - Country:US
Practice Address - Phone:740-383-8022
Practice Address - Fax:740-383-7942
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT002375225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4148781OtherPALMETTO MEDICARE
000000351677OtherANTHEM
000000351677OtherANTHEM
4148781OtherPALMETTO MEDICARE