Provider Demographics
NPI:1063480911
Name:WAY, ELIZABETH (OT)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:WAY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 BLANDING STREET
Mailing Address - Street 2:MIDLANDS ORTHOPAEDICS, PA
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3520
Mailing Address - Country:US
Mailing Address - Phone:803-256-4107
Mailing Address - Fax:803-253-6676
Practice Address - Street 1:1910 BLANDING STREET
Practice Address - Street 2:MIDLANDS ORTHOPAEDICS, PA
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3520
Practice Address - Country:US
Practice Address - Phone:803-256-4107
Practice Address - Fax:803-253-6676
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1560225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1560OtherOT LICENSE #