MEDICARE: MRS. ELIZABETH PHILLIPS NELSON

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	225XR0403X	Driving and Community Mobility Occupational Therapist	0446	NC
2	225XR0403X	Driving and Community Mobility Occupational Therapist	446	NC

General Provider Information

NPI Number	:	1679747687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH PHILLIPS NELSON

Provider Business Mailing Address
First Line	:	425 YATES RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-4516
Country	:	US
Telephone Number	:	336-774-0074
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 YATES RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-4516
Country	:	US
Telephone Number	:	877-781-9565
Fax Number	:

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

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	05/12/2008

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