Provider Demographics
NPI:1912660465
Name:HUBBARD, ELIZABETH CARMELL (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CARMELL
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 LIGHTHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7019
Mailing Address - Country:US
Mailing Address - Phone:662-292-8060
Mailing Address - Fax:
Practice Address - Street 1:276 NISSAN PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-7006
Practice Address - Country:US
Practice Address - Phone:601-808-3028
Practice Address - Fax:601-510-9665
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3892225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist