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General NPI Number Information
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NPI Number | 1093980047
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Entity Type | Individual
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Provider Name | MISTY ELMORE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 3703 WEST LAKE AVENUE SUITE 200
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City | GLENVIEW
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State | IL
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Zip | 60026-1223
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Country | US
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Telephone | 847-998-1188
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Fax |
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Provider Business Mailing Address
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Address Line | 450 NEW MARKET BLVD STE 3
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City | BOONE
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State | NC
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Zip | 28607-5501
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Country | US
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Telephone | 828-355-9584
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Fax | 828-355-9689
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056007320
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License Number State | IL
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