Healthcare Provider Details

I. General information

NPI: 1992459226
Provider Name (Legal Business Name): ELIZABETH UHLMANN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH POWERS

II. Dates (important events)

Enumeration Date: 02/06/2022
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 BOSTON ST SE
GRAND RAPIDS MI
49506-4185
US

IV. Provider business mailing address

2882 WEXFORD DR
SAGINAW MI
48603-3239
US

V. Phone/Fax

Practice location:
  • Phone: 616-245-9179
  • Fax:
Mailing address:
  • Phone: 989-484-0624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303024100
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202008756
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: