Provider Demographics
NPI:1932133311
Name:FAIN, ELIZABETH ANNE (OTR L)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:FAIN
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 1:2713 TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5215
Mailing Address - Country:US
Mailing Address - Phone:336-725-2817
Mailing Address - Fax:336-983-4915
Practice Address - Street 1:2315 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5801
Practice Address - Country:US
Practice Address - Phone:336-727-2440
Practice Address - Fax:336-727-2873
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0839225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC807864OtherREHABILITATIVE MEDICINE
NC7331042Medicaid
NC31042OtherREHABILITATIVE MEDICINE
NC186542OtherREHABILITATIVE MEDICINE
NC7331042Medicaid