MEDICARE: STEPHANIE NICOLE ELHART OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	1051188

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104942796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE NICOLE ELHART OTR

Provider Business Mailing Address
First Line	:	2210 LELARAY ST
Second Line	:
City	:	COLO SPGS
State	:	CO
Zip	:	80909
Country	:	US
Telephone Number	:	719-475-0477
Fax Number	:	719-475-1021

Provider Business Practice Location Address
First Line	:	2210 LELARAY ST
Second Line	:
City	:	COLO SPGS
State	:	CO
Zip	:	80909
Country	:	US
Telephone Number	:	719-475-0477
Fax Number	:	719-475-1021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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