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General NPI Number Information
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NPI Number | 1851857809
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Entity Type | Individual
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Provider Name | LORRAINE PROSSER ELLIOTT
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Gender | Female
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Dates
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Enumeration Date | 02/14/2019
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Last Update Date | 02/14/2019
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Provider Practice Location Address
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Address Line | 11974 EDGEHILL TERRACE RD
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City | PRINCESS ANNE
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State | MD
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Zip | 21853-2105
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Country | US
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Telephone | 410-651-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 28109 CROSS CREEK DR
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City | SALISBURY
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State | MD
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Zip | 21801-2521
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Country | US
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Telephone | 880-910-9329
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Fax |
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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 | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number | 06157
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License Number State | MD
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