Healthcare Provider Details

I. General information

NPI: 1922555606
Provider Name (Legal Business Name): ELIZABETH MARY HUMANITZKI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1367 TARA RD
CHARLESTON SC
29407-5131
US

IV. Provider business mailing address

PO BOX 1753
MT PLEASANT SC
29465-1753
US

V. Phone/Fax

Practice location:
  • Phone: 412-780-4035
  • Fax: 866-394-5788
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4807
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: