Provider Demographics
NPI:1154736858
Name:RYAN, ELIZABETH KRAUS
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:KRAUS
Last Name:RYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LYNN
Other - Last Name:KRAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:830 W 40TH ST
Mailing Address - Street 2:REHABILITATION DEPARTMENT
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2116
Mailing Address - Country:US
Mailing Address - Phone:410-243-7699
Mailing Address - Fax:
Practice Address - Street 1:830 W 40TH ST
Practice Address - Street 2:REHABILITATION DEPARTMENT
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2116
Practice Address - Country:US
Practice Address - Phone:410-243-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02146224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant