Healthcare Provider Details

I. General information

NPI: 1225833809
Provider Name (Legal Business Name): ELIZABETH WERNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 HIGH ST
BOSTON MA
02110-3001
US

IV. Provider business mailing address

16 S 5TH ST
PARK RIDGE NJ
07656-1920
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-7598
  • Fax:
Mailing address:
  • Phone: 201-470-0799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR01220600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: