Provider Demographics
NPI:1649302043
Name:MCANULTY, ELIZABETH REID (MS OTR)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:REID
Last Name:MCANULTY
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-2329
Mailing Address - Country:US
Mailing Address - Phone:413-529-9541
Mailing Address - Fax:
Practice Address - Street 1:243 KING ST
Practice Address - Street 2:SUITE 242
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2451
Practice Address - Country:US
Practice Address - Phone:413-584-0265
Practice Address - Fax:413-584-2031
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5252174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist