Provider Demographics
NPI:1902111032
Name:REPPERT, ELIZABETH K (OT/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:REPPERT
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 KNOLLBROOK LN W
Mailing Address - Street 2:
Mailing Address - City:PAINTED POST
Mailing Address - State:NY
Mailing Address - Zip Code:14870-9346
Mailing Address - Country:US
Mailing Address - Phone:607-973-2780
Mailing Address - Fax:
Practice Address - Street 1:5 KNOLLBROOK LN W
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-9346
Practice Address - Country:US
Practice Address - Phone:607-973-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014807-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics