MEDICARE: ELIZABETH RICHARDS SEIDLITZ M.S., 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	017791	NY

General Provider Information

NPI Number	:	1942542303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH RICHARDS SEIDLITZ M.S., OTR/L

Provider Business Mailing Address
First Line	:	406 PROSPECT AVE
Second Line	:	APT 2
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5609
Country	:	US
Telephone Number	:	202-255-0566
Fax Number	:

Provider Business Practice Location Address
First Line	:	406 PROSPECT AVE
Second Line	:	APT 2
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5609
Country	:	US
Telephone Number	:	202-255-0566
Fax Number	:

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

Provider Enumeration Date	:	03/25/2013
Last Update Date	:	05/10/2013

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