Provider Demographics
NPI:1902237092
Name:DEAN, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5980 RADIO STATION RD
Mailing Address - Street 2:PO BOX 2770
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646
Mailing Address - Country:US
Mailing Address - Phone:301-932-6610
Mailing Address - Fax:
Practice Address - Street 1:5980 RADIO STATION RD
Practice Address - Street 2:PO BOX 2770
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646
Practice Address - Country:US
Practice Address - Phone:301-932-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-28
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
MEOT2813225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist