Provider Demographics
NPI:1487872420
Name:FELTEN, ELIZABETH A (OTR L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:FELTEN
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:300 DODRIDGE
Mailing Address - City:BLACKWATER
Mailing Address - State:MO
Mailing Address - Zip Code:65322-0117
Mailing Address - Country:US
Mailing Address - Phone:660-846-2461
Mailing Address - Fax:660-846-2431
Practice Address - Street 1:BLACKWATER R-II
Practice Address - Street 2:300 DODRIDGE
Practice Address - City:BLACKWATER
Practice Address - State:MO
Practice Address - Zip Code:65322-0117
Practice Address - Country:US
Practice Address - Phone:660-846-2461
Practice Address - Fax:660-846-2431
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000311225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO476814512Medicaid