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NPI Code Detail

MEDICARE: ELIZABETH M SLACK

MEDICARE: ELIZABETH M SLACK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist5201006851MI

General Provider Information

NPI Number : 1164863296
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH M SLACK
Provider Business Mailing Address
First Line : 1900 S LACHANCE RD
Second Line :
City : LAKE CITY
State : MI
Zip : 49651-8022
Country : US
Telephone Number : 231-775-3081
Fax Number : 231-775-7740
Provider Business Practice Location Address
First Line : 1900 S LACHANCE RD
Second Line :
City : LAKE CITY
State : MI
Zip : 49651-8022
Country : US
Telephone Number : 231-775-3081
Fax Number : 231-775-7740
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2013
Last Update Date : 07/17/2013

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