Provider Demographics
NPI:1700064581
Name:BROUGHTON, ELIZABETH K (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 BONNIE ST
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-4603
Mailing Address - Country:US
Mailing Address - Phone:919-614-5054
Mailing Address - Fax:
Practice Address - Street 1:2233 BONNIE ST
Practice Address - Street 2:
Practice Address - City:WILLOW SPRING
Practice Address - State:NC
Practice Address - Zip Code:27592-4603
Practice Address - Country:US
Practice Address - Phone:919-614-5054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7386225XP0200X
NC6728225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics