Most Relevant Information
Provider Data
| NPI Number: | 1003283284 |
| Provider Name: | ELISABETH NEELY THEODOSSIOU OTR/L |
| Entity Type: | Individual |
| Taxonomy Code: | 225X00000X |
| Specialty: | Occupational Therapist |
| License Number: | 9719 |
Most Important Dates
| Enumeration Date: | 08/24/2015 |
| Last Updated: | 08/24/2015 |
Provider Practice Location
1100 BLYTHE BLVD
CHARLOTTE
NC
282035814
Practice Location Phone/Fax
| Phone: | 7043554370 |
| Fax: |
Provider Mailing Location
1100 BLYTHE BLVD
CHARLOTTE
NC
282035814
Provider Mailing Phone/Fax
| Phone: | 7043554370 |
| Fax: |