Provider Demographics
NPI:1790168433
Name:WOMACK, ELIZABETH KOPP (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KOPP
Last Name:WOMACK
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:KOPP
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ORT/L
Mailing Address - Street 1:3925 MIDLANDS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2575
Mailing Address - Country:US
Mailing Address - Phone:757-585-3216
Mailing Address - Fax:757-561-2541
Practice Address - Street 1:3925 MIDLANDS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2575
Practice Address - Country:US
Practice Address - Phone:757-585-3216
Practice Address - Fax:757-561-2541
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006599225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist