Provider Demographics
NPI:1972174068
Name:FUNK, ELIZABETH R (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:FUNK
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6132 ROCKVILLE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3806
Mailing Address - Country:US
Mailing Address - Phone:651-280-9596
Mailing Address - Fax:
Practice Address - Street 1:5265 N ACADEMY BLVD STE 3300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4082
Practice Address - Country:US
Practice Address - Phone:888-701-9216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0006909225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist