Provider Demographics
NPI:1912506247
Name:HADHAZY, ELIZABETH L (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:HADHAZY
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 1:5 W BOULDER CT APT A
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-2347
Mailing Address - Country:US
Mailing Address - Phone:708-639-8226
Mailing Address - Fax:
Practice Address - Street 1:5 W BOULDER CT APT A
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-2347
Practice Address - Country:US
Practice Address - Phone:708-639-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
09161993OtherLH NUMBER