Active NPI
Elizabeth Mary Cormack, OTR L
- Occupational Therapist
- Glen Morgan, WV
National Provider Identifier
1497958557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 695
- Practice address
- 136 Sullivan Rd
Glen Morgan, WV 25813-7600 - Phone
- (304) 256-4555
- NPI assigned
- Jun 7, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 695 | WV | Primary |
Addresses
Primary practice location
136 Sullivan Rd
Glen Morgan, WV 25813-7600
Mailing address
109 West Locust Drive
Beckley, WV 25801
Phone (304) 256-0609
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 695 | WV | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192147200000",
"number": "1497958557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 WEST LOCUST DRIVE",
"city": "BECKLEY",
"state": "WV",
"postal_code": "25801",
"telephone_number": "304-256-0609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "136 SULLIVAN RD",
"city": "GLEN MORGAN",
"state": "WV",
"postal_code": "258137600",
"telephone_number": "304-256-4555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORMACK",
"first_name": "ELIZABETH",
"middle_name": "MARY",
"credential": "OTR L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-07",
"last_updated": "2007-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WV",
"license": "695",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glen Morgan, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.