Elizabeth Cooper Porter, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

132707 Issued in KY

Practice address

210 Traditions Ave
Bowling Green, KY 42103

Phone

(606) 303-8634

Fax

(317) 520-8200

NPI assigned

Nov 28, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1322438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656633600000",
    "number": "1083981559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 AUGUSTA AVE",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421032537",
            "telephone_number": "606-303-8634",
            "fax_number": "317-520-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 TRADITIONS AVE",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "42103",
            "telephone_number": "606-303-8634",
            "fax_number": "317-520-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "ELIZABETH",
        "middle_name": "COOPER",
        "name_prefix": "Ms.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-11-28",
        "last_updated": "2022-07-01",
        "certification_date": "2022-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "KY",
            "license": "RO183",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "KY",
            "license": "132707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100332170",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mackenzie Polston
• Samantha Roxanne Polston, APRN
• Krystle Elizabeth Pope, MED, BCBA, LBA
• Stephanie Popovic, BHS
• Amanda Porter, MD
• Grace Marie Porter, COTA
• Madison Porter
• Michelle L Porter, BHS
• Amanda Portman, LCSW
• Shaina Portman

• Pediatric Occupational Therapist in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Pediatric Occupational Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.