Healthcare Provider Details

I. General information

NPI: 1821277484
Provider Name (Legal Business Name): ELIZABETH M REITER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N JEFFERSON ST
ROANOKE VA
24016-1427
US

IV. Provider business mailing address

650 N JEFFERSON ST
ROANOKE VA
24016-1427
US

V. Phone/Fax

Practice location:
  • Phone: 540-345-5111
  • Fax:
Mailing address:
  • Phone: 540-345-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119005489
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: