Provider Demographics
NPI:1487147179
Name:HAIR, ELIZABETH NOELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NOELLE
Last Name:HAIR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6864 SUSQUEHANNA TRL S
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-9320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6864 SUSQUEHANNA TRL S
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-9320
Practice Address - Country:US
Practice Address - Phone:717-428-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08418225X00000X
PAOC015658225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC015658OtherBUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS
MD08418OtherMARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE