Provider Demographics
NPI:1538620752
Name:JARRELL, ELIZABETH ELDRIDGE (OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ELDRIDGE
Last Name:JARRELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7308 WALDEN CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-9539
Mailing Address - Country:US
Mailing Address - Phone:770-298-6181
Mailing Address - Fax:
Practice Address - Street 1:403 WATERFRONT CT
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-2730
Practice Address - Country:US
Practice Address - Phone:770-298-6181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007282225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist