Healthcare Provider Details

I. General information

NPI: 1740064641
Provider Name (Legal Business Name): ELIZABETH ANNE ELLIOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 HALE PKWY
DENVER CO
80220-6210
US

IV. Provider business mailing address

728 S DEPEW ST
LAKEWOOD CO
80226-4854
US

V. Phone/Fax

Practice location:
  • Phone: 844-757-7450
  • Fax:
Mailing address:
  • Phone: 661-205-3429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0008054
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: