Provider Demographics
NPI:1255690301
Name:ELSHAZLY, MICAELA ROSE (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MICAELA
Middle Name:ROSE
Last Name:ELSHAZLY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MS
Other - First Name:MICAELA
Other - Middle Name:ROSE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:6693 CORTE MARIA
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-5917
Mailing Address - Country:US
Mailing Address - Phone:714-330-8417
Mailing Address - Fax:858-966-5859
Practice Address - Street 1:11590 W BERNARDO CT
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1624
Practice Address - Country:US
Practice Address - Phone:858-432-4749
Practice Address - Fax:858-432-4750
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT14517225X00000X
CAOT 14517225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist