Healthcare Provider Details

I. General information

NPI: 1750736872
Provider Name (Legal Business Name): ELIZABETH BEJCEK OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 PROFESSIONAL PKWY
SANTA MARIA CA
93455-8200
US

IV. Provider business mailing address

2530 PROFESSIONAL PKWY
SANTA MARIA CA
93455-8200
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-4465
  • Fax: 805-928-7935
Mailing address:
  • Phone: 805-928-4465
  • Fax: 805-928-7935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT16149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: