Basic Information
| Provider Information | |||||||||
| NPI: | 1154406189 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERMEDAHL | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 604 COPELAND ST | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537111710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082490443 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14 ELLIS POTTER CT STE 200 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537112478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082046242 | ||||||||
| FaxNumber: | 6082046249 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 1061924 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 086G3VE | 01 | MN | BCBS | OTHER | HP-47136 | 01 | MN | HEALTHPARTNERS | OTHER | 64-05160 | 01 | MN | MEDICA | OTHER |