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
Mailing Address - Street 1:7103 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6641
Mailing Address - Country:US
Mailing Address - Phone:505-508-0505
Mailing Address - Fax:505-508-0505
Practice Address - Street 1:7103 4TH ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6641
Practice Address - Country:US
Practice Address - Phone:505-508-0505
Practice Address - Fax:505-508-0505
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-29
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM423225XH1200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics