Provider Demographics
NPI:1700919792
Name:STORM, ELIZABETH CLARE (OTR-L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CLARE
Last Name:STORM
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 1:54 S BOW RD
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-5600
Mailing Address - Country:US
Mailing Address - Phone:978-314-5607
Mailing Address - Fax:
Practice Address - Street 1:235 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-4314
Practice Address - Country:US
Practice Address - Phone:603-627-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2084225X00000X
MA8827225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist