Provider Demographics
NPI:1427218395
Name:MOTTELER, ELIZABETH LEWIS (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEWIS
Last Name:MOTTELER
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313-A EXECUTIVE PARK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3744
Mailing Address - Country:US
Mailing Address - Phone:252-830-8575
Mailing Address - Fax:232-850-8576
Practice Address - Street 1:2313-A EXECUTIVE PARK CIRCLE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3744
Practice Address - Country:US
Practice Address - Phone:252-830-8575
Practice Address - Fax:232-850-8576
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC840235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist