Provider Demographics
NPI:1992013171
Name:WARD, ELIZABETH COCKRILL (CMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:COCKRILL
Last Name:WARD
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4006
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-4006
Mailing Address - Country:US
Mailing Address - Phone:970-309-0976
Mailing Address - Fax:
Practice Address - Street 1:264 CODY LN
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-9106
Practice Address - Country:US
Practice Address - Phone:970-927-2532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT - 5540225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist