Provider Demographics
NPI:1265125256
Name:THAYER, ELIZABETH MCDONOUGH (MS OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MCDONOUGH
Last Name:THAYER
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Gender:F
Credentials:MS OTR/L
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Mailing Address - Street 1:348 MARCUS GARVEY BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-5719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:348 MARCUS GARVEY BLVD APT 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-5719
Practice Address - Country:US
Practice Address - Phone:646-926-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY027860-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist