Provider Demographics
NPI:1215118146
Name:WARGO, ELIZABETH C (OTR)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:WARGO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 GLENTON DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3413
Mailing Address - Country:US
Mailing Address - Phone:419-215-8428
Mailing Address - Fax:
Practice Address - Street 1:840 W BOUNDARY ST STE 3
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1702
Practice Address - Country:US
Practice Address - Phone:419-215-8428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA02757224Z00000X
OH007141225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant