Provider Demographics
NPI:1811566565
Name:MCWHIRTER, ELIZABETH AMELIA (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:AMELIA
Last Name:MCWHIRTER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2012 W DELRAY DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-3306
Mailing Address - Country:US
Mailing Address - Phone:309-657-1032
Mailing Address - Fax:
Practice Address - Street 1:5533 N GALENA RD
Practice Address - Street 2:
Practice Address - City:PEORIA HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:61616-4447
Practice Address - Country:US
Practice Address - Phone:309-682-5428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.004134224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant