Provider Demographics
NPI:1083092522
Name:BRAUN, ELISABETH (MOT/L)
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:
Last Name:BRAUN
Suffix:
Gender:F
Credentials:MOT/L
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:
Other - Last Name:DODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2212 WASHINGTON AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2621
Mailing Address - Country:US
Mailing Address - Phone:202-256-7844
Mailing Address - Fax:
Practice Address - Street 1:2212 WASHINGTON AVE APT 101
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2621
Practice Address - Country:US
Practice Address - Phone:202-256-7844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-17
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC100000064225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist