Provider Demographics
NPI:1407366065
Name:MATEJCIK, ELIZABETH NICOLE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:NICOLE
Last Name:MATEJCIK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:NICOLE
Other - Last Name:DENZIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:234 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-4701
Mailing Address - Country:US
Mailing Address - Phone:623-694-8954
Mailing Address - Fax:
Practice Address - Street 1:940 E WILLIAMS FIELD RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-5700
Practice Address - Country:US
Practice Address - Phone:480-812-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-005949225X00000X
IN31006915A225X00000X
AZ5946225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology