MEDICARE: ELIZABETH A ANDERSON OTA

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	224Z00000X	Occupational Therapy Assistant		TX

General Provider Information

NPI Number	:	1427254929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH A ANDERSON OTA

Provider Business Mailing Address
First Line	:	15865 GORDON CUMMINGS RD
Second Line	:
City	:	CANYON
State	:	TX
Zip	:	79015-7255
Country	:	US
Telephone Number	:	806-223-9533
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 S CLEVELAND ST
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79102-4211
Country	:	US
Telephone Number	:	806-677-5236
Fax Number	:

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

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	05/17/2016

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