Provider Demographics
NPI:1760136774
Name:ROMINE, ELIZABETH CAROLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CAROLE
Last Name:ROMINE
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 1:80 COUNTY ROAD 1162
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35057-0646
Mailing Address - Country:US
Mailing Address - Phone:813-629-1299
Mailing Address - Fax:
Practice Address - Street 1:1640 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5313
Practice Address - Country:US
Practice Address - Phone:256-841-5185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5769225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist