Provider Demographics
NPI:1073727541
Name:SIROIS, ELIZABETH RENE (COTAL)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:RENE
Last Name:SIROIS
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:RENE
Other - Last Name:BLOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTAL
Mailing Address - Street 1:37 ELLIS DR
Mailing Address - Street 2:
Mailing Address - City:DENNIS PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02639-1507
Mailing Address - Country:US
Mailing Address - Phone:508-394-5089
Mailing Address - Fax:
Practice Address - Street 1:63 DANBURY ROAD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897
Practice Address - Country:US
Practice Address - Phone:800-278-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1016224Z00000X
ARA415224Z00000X
CA1232224Z00000X
NH0213224Z00000X
FL07884224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant