Provider Demographics
NPI:1164889721
Name:GARCIA, ELLEN DRIEGHE (MA, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:DRIEGHE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1731
Mailing Address - Country:US
Mailing Address - Phone:413-301-8021
Mailing Address - Fax:
Practice Address - Street 1:35 HOLY FAMILY RD
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2701
Practice Address - Country:US
Practice Address - Phone:413-532-3246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11078225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist