Provider Demographics
NPI:1023772605
Name:HARTLEY, ELIZABETH ADEN (COTA/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ADEN
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ADEN
Other - Last Name:BASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:118 E CAMP KIRO RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-8015
Mailing Address - Country:US
Mailing Address - Phone:252-230-6437
Mailing Address - Fax:
Practice Address - Street 1:2600 OLD CHERRY POINT RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-6778
Practice Address - Country:US
Practice Address - Phone:252-637-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11013224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant