Provider Demographics
NPI:1184894123
Name:GREEN, ELIZABETH EGGELING (OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:EGGELING
Last Name:GREEN
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 1:222 STARCREST RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-8242
Mailing Address - Country:US
Mailing Address - Phone:202-415-4413
Mailing Address - Fax:
Practice Address - Street 1:222 STARCREST RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-8242
Practice Address - Country:US
Practice Address - Phone:202-415-4413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003991225X00000X
DCOT010000203225X00000X
COOT.0002973225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist