MEDICARE: MS. ELIZABETH VISSER 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	OT00003199	WA
2	225XH1200X	Hand Occupational Therapist	31006709A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801139530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH VISSER OTR/L

Provider Business Mailing Address
First Line	:	3245 HEALTH DRIVE
Second Line	:	SUITE 100
City	:	GRANGER
State	:	IN
Zip	:	46530-1380
Country	:	US
Telephone Number	:	574-647-1840
Fax Number	:

Provider Business Practice Location Address
First Line	:	3221 BEACON PKWY STE 100
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-7196
Country	:	US
Telephone Number	:	574-647-2930
Fax Number	:	574-647-2935

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

Provider Enumeration Date	:	04/01/2013
Last Update Date	:	02/07/2024

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