Provider Demographics
NPI:1174996367
Name:HARES, ELIZABETH KATHLEEN (OTR/L MOT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KATHLEEN
Last Name:HARES
Suffix:
Gender:F
Credentials:OTR/L MOT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:KATHLEEN
Other - Last Name:HARES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/ L MOT MASTERS
Mailing Address - Street 1:861 AUTO CENTER DR.
Mailing Address - Street 2:#D
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551
Mailing Address - Country:US
Mailing Address - Phone:661-945-7878
Mailing Address - Fax:661-945-7553
Practice Address - Street 1:861 AUTO CENTER DR.
Practice Address - Street 2:#D
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551
Practice Address - Country:US
Practice Address - Phone:661-945-7878
Practice Address - Fax:661-945-7553
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15673225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist