Provider Demographics
NPI:1245931849
Name:FOSTER, ELIZABETH A (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:FOSTER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5188 E HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-8761
Mailing Address - Country:US
Mailing Address - Phone:606-307-3058
Mailing Address - Fax:
Practice Address - Street 1:5188 E HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-8761
Practice Address - Country:US
Practice Address - Phone:606-307-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY132704225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist