MEDICARE: ELIZABETH JORDAN OTRL

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

General Provider Information

NPI Number	:	1710337100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH JORDAN OTRL

Provider Business Mailing Address
First Line	:	11287 HOSFORD RD
Second Line	:
City	:	CHARDON
State	:	OH
Zip	:	44024-9640
Country	:	US
Telephone Number	:	216-223-8761
Fax Number	:

Provider Business Practice Location Address
First Line	:	5247 WILSON MILLS RD # 126
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-3016
Country	:	US
Telephone Number	:	216-223-8761
Fax Number	:	309-423-4813

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

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	06/15/2016

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