Healthcare Provider Details

I. General information

NPI: 1568141760
Provider Name (Legal Business Name): ELIZABETH MASTERSON OTR/L, CBIS, CTP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH COPEMAN

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 17TH ST N APT 165
VIRGINIA MN
55792-2181
US

IV. Provider business mailing address

321 6TH ST NE
CHISHOLM MN
55719-1287
US

V. Phone/Fax

Practice location:
  • Phone: 605-541-1000
  • Fax:
Mailing address:
  • Phone: 218-969-7834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number106814
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: