Provider Demographics
NPI:1902151285
Name:RHODUS, ELIZABETH KELLY (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:KELLY
Last Name:RHODUS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:KELLY
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:370 HIGHLAND PARK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3546
Mailing Address - Country:US
Mailing Address - Phone:859-623-4567
Mailing Address - Fax:
Practice Address - Street 1:370 HIGHLAND PARK DR STE 1
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3546
Practice Address - Country:US
Practice Address - Phone:859-623-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15319225XP0200X, 225X00000X
KYR-5661225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
K090590OtherMEDICARE ID
FL006789200Medicaid
FL880357904OtherOCA
FL880357900OtherOCA