Provider Demographics
NPI:1699896878
Name:ROSS-GULYAS, ELIZABETH HORTON (OTR)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:HORTON
Last Name:ROSS-GULYAS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15904 WAPPES RD
Mailing Address - Street 2:
Mailing Address - City:CHURUBUSCO
Mailing Address - State:IN
Mailing Address - Zip Code:46723-9438
Mailing Address - Country:US
Mailing Address - Phone:260-693-6171
Mailing Address - Fax:260-693-3574
Practice Address - Street 1:15904 WAPPES RD
Practice Address - Street 2:
Practice Address - City:CHURUBUSCO
Practice Address - State:IN
Practice Address - Zip Code:46723-9438
Practice Address - Country:US
Practice Address - Phone:260-693-6171
Practice Address - Fax:260-693-3574
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000419A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist