Provider Demographics
NPI:1235365511
Name:WELLS, ELIZABETH CHAYA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:CHAYA
Last Name:WELLS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:BETTY
Other - Middle Name:SUSAN
Other - Last Name:CHAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:EMIGRANT GAP
Mailing Address - State:CA
Mailing Address - Zip Code:95715-0148
Mailing Address - Country:US
Mailing Address - Phone:530-388-8048
Mailing Address - Fax:775-688-2984
Practice Address - Street 1:2667 ENTERPRISE RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-1666
Practice Address - Country:US
Practice Address - Phone:775-688-1341
Practice Address - Fax:775-688-2984
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0021225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist