Provider Demographics
NPI:1366546657
Name:KURTZ, ELIZABETH ARDLEY (OTRL)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ARDLEY
Last Name:KURTZ
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:ARDLEY
Other - Last Name:KURTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTRL
Mailing Address - Street 1:16 MARTIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9728
Mailing Address - Country:US
Mailing Address - Phone:207-883-1532
Mailing Address - Fax:207-883-9739
Practice Address - Street 1:20 JAMESON HILL ROAD
Practice Address - Street 2:JAMESON SCHOOL
Practice Address - City:OLD ORCHARD BEACH
Practice Address - State:ME
Practice Address - Zip Code:04064-1606
Practice Address - Country:US
Practice Address - Phone:207-934-2891
Practice Address - Fax:207-937-3710
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1140225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME023187OtherANTHEM BCBS