Provider Demographics
NPI:1851857809
Name:ELLIOTT, LORRAINE PROSSER
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:PROSSER
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28109 CROSS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2521
Mailing Address - Country:US
Mailing Address - Phone:880-910-9329
Mailing Address - Fax:
Practice Address - Street 1:11974 EDGEHILL TERRACE RD
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-2105
Practice Address - Country:US
Practice Address - Phone:410-651-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06157225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology