Provider Demographics
NPI:1427254929
Name:ANDERSON, ELIZABETH A (OTA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15865 GORDON CUMMINGS RD
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-7255
Mailing Address - Country:US
Mailing Address - Phone:806-223-9533
Mailing Address - Fax:
Practice Address - Street 1:1601 S CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-4211
Practice Address - Country:US
Practice Address - Phone:806-677-5236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant