Provider Demographics
NPI:1831343979
Name:LOCNIKAR, ELIZABETH GRACE (MS, OTR, ATC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GRACE
Last Name:LOCNIKAR
Suffix:
Gender:F
Credentials:MS, OTR, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 CONNECTICUT AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377
Mailing Address - Country:US
Mailing Address - Phone:320-259-4141
Mailing Address - Fax:320-257-7811
Practice Address - Street 1:1901 CONNECTICUT AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377
Practice Address - Country:US
Practice Address - Phone:320-259-4141
Practice Address - Fax:320-257-7811
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-004762255A2300X
MN21362255A2300X
MN103668225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer