Provider Demographics
NPI:1548627789
Name:COX, ELIZABETH LOUISE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LOUISE
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ROXANA
Mailing Address - State:IL
Mailing Address - Zip Code:62084-1201
Mailing Address - Country:US
Mailing Address - Phone:618-540-1093
Mailing Address - Fax:
Practice Address - Street 1:141 W 1ST ST
Practice Address - Street 2:
Practice Address - City:ROXANA
Practice Address - State:IL
Practice Address - Zip Code:62084-1201
Practice Address - Country:US
Practice Address - Phone:618-540-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer