MEDICARE: ELIZABETH BONTRAGER MOT, OTR/L

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	120315	TX

General Provider Information

NPI Number	:	1477196095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH BONTRAGER MOT, OTR/L

Provider Business Mailing Address
First Line	:	5757 WOODWAY DR STE 202
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-1533
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5757 WOODWAY DR STE 202
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-1533
Country	:	US
Telephone Number	:	713-977-0730
Fax Number	:

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

Provider Enumeration Date	:	10/27/2019
Last Update Date	:	02/23/2023

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