Provider Demographics
NPI:1245537380
Name:RADLIFF, ELIZABETH ANN (COTA/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:RADLIFF
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WHITAKER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:ME
Mailing Address - Zip Code:04987-3430
Mailing Address - Country:US
Mailing Address - Phone:207-948-3320
Mailing Address - Fax:
Practice Address - Street 1:37 POND ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4641
Practice Address - Country:US
Practice Address - Phone:207-945-4334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA2491224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant