Provider Demographics
NPI:1851049191
Name:COLLINS, ELIZABETH RUSSELL (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RUSSELL
Last Name:COLLINS
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 1:8713 SALLY CT
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-6049
Mailing Address - Country:US
Mailing Address - Phone:317-379-2524
Mailing Address - Fax:
Practice Address - Street 1:8713 SALLY CT
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-6049
Practice Address - Country:US
Practice Address - Phone:317-379-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA308023225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist