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NPI Code Detail

MEDICARE: MS. ELIZABETH ANN WIVELL OTR/L, L.AC. , DACM

MEDICARE: MS. ELIZABETH ANN WIVELL OTR/L, L.AC. , DACM
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
1171100000XAcupuncturist003825NY
2225X00000XOccupational Therapist008629NY
3174400000XSpecialist

General Provider Information

NPI Number : 1497811889
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELIZABETH ANN WIVELL OTR/L, L.AC. , DACM
Provider Business Mailing Address
First Line : 3 STUYVESANT OVAL
Second Line : APT 9G
City : NEW YORK CITY
State : NY
Zip : 10009
Country : US
Telephone Number : 917-474-7821
Fax Number :
Provider Business Practice Location Address
First Line : 34 WEST 27TH STREET
Second Line : SUITE 1212
City : NEW YORK CITY
State : NY
Zip : 10001-2320
Country : US
Telephone Number : 917-474-7821
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2006
Last Update Date : 05/11/2021

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