Provider Demographics
NPI:1790225191
Name:NUTT, ELIZABETH (COTA/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:NUTT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 RIVERWAY LN
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7608
Mailing Address - Country:US
Mailing Address - Phone:601-594-2746
Mailing Address - Fax:
Practice Address - Street 1:260 VILLAGE LAKE RD
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-1820
Practice Address - Country:US
Practice Address - Phone:919-742-4052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10704224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant