Provider Demographics
NPI:1063961217
Name:PULLIAM, ELIZABETH STOKES (MS OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:STOKES
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BRUCE RD
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-4177
Mailing Address - Country:US
Mailing Address - Phone:540-272-4324
Mailing Address - Fax:615-375-7182
Practice Address - Street 1:510 BRUCE RD
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-4177
Practice Address - Country:US
Practice Address - Phone:540-272-4324
Practice Address - Fax:615-375-7182
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000005487174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist