Provider Demographics
NPI:1184255317
Name:PORTER, ELIZABETH KAY
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KAY
Last Name:PORTER
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 1:5917 N OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2921
Mailing Address - Country:US
Mailing Address - Phone:317-919-7497
Mailing Address - Fax:
Practice Address - Street 1:9730 PRAIRIE LAKES BLVD E
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4766
Practice Address - Country:US
Practice Address - Phone:317-770-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005043A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist