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1508656331 NPI number — ELIZABETH ELLINGSON OTR/L

NPI Number: 1508656331
Health Care Provider/Practitioner: ELIZABETH ELLINGSON OTR/L

Information about “1508656331” NPI (ELIZABETH ELLINGSON OTR/L) exists in 1508656331 in HTML format HTML  |  1508656331 in plain Text format TXT  |  1508656331 in PDF (Portable Document Format) PDF  |  1508656331 in an XML format XML  formats.

NPI Number : 1508656331 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1508656331",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ELLINGSON",
    "FirstName": "ELIZABETH",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "OTR/L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KUESTER",
    "OtherFirstName": "ELIZABETH",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "OTR/L",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "5803 NEAL AVE N",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STILLWATER",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55082-2177",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5803 NEAL AVE N",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STILLWATER",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55082-2177",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "651-472-6107",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/06/2025",
    "LastUpdateDate": "05/06/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225X00000X",
        "TaxonomyName": "Occupational Therapist",
        "LicenseNumber": "103230",
        "LicenseNumberStateCode": "MN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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