Provider Demographics
NPI:1750260576
Name:NGUYEN, ELIZABETH KIM (OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KIM
Last Name:NGUYEN
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 1:16118 W PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:TRIVOLI
Mailing Address - State:IL
Mailing Address - Zip Code:61569-9751
Mailing Address - Country:US
Mailing Address - Phone:952-688-3217
Mailing Address - Fax:
Practice Address - Street 1:5301 W EVERETT M DIRKSEN PKWY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61607-1126
Practice Address - Country:US
Practice Address - Phone:309-681-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist