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NPI Code Detail

MEDICARE: ELAINE RYAN OT/L

MEDICARE: ELAINE RYAN OT/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
1225X00000XOccupational Therapist4004NC

General Provider Information

NPI Number : 1811285513
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELAINE RYAN OT/L
Provider Business Mailing Address
First Line : 116 WILDIRIS DR
Second Line :
City : MOORESVILLE
State : NC
Zip : 28117-3709
Country : US
Telephone Number : 704-660-7762
Fax Number :
Provider Business Practice Location Address
First Line : 16409 NORTHCROSS DR
Second Line :
City : HUNTERSVILLE
State : NC
Zip : 28078-5065
Country : US
Telephone Number : 980-441-8200
Fax Number : 980-441-8202
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2011
Last Update Date : 06/22/2026

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