Provider Demographics
NPI:1366433450
Name:DILLARD, ELIZABETH A (MS, OTR, L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:DILLARD
Suffix:
Gender:F
Credentials:MS, OTR, L
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:VIGIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR, L; LMT
Mailing Address - Street 1:7 WYLIE LN
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-7913
Mailing Address - Country:US
Mailing Address - Phone:505-508-0505
Mailing Address - Fax:505-312-8414
Practice Address - Street 1:3815 OSUNA RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4430
Practice Address - Country:US
Practice Address - Phone:505-508-0505
Practice Address - Fax:505-312-8414
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-29
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMT-2024-0084225700000X, 225700000X
NMOT423225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist