Provider Demographics
NPI:1336301357
Name:MICHAUD-HANSON, ELISA BETH (PA, OT)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:BETH
Last Name:MICHAUD-HANSON
Suffix:
Gender:F
Credentials:PA, OT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:11107 HOMRIGHAUS RD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77554-9479
Mailing Address - Country:US
Mailing Address - Phone:281-788-6661
Mailing Address - Fax:
Practice Address - Street 1:2100 WEST LOOP S
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-3515
Practice Address - Country:US
Practice Address - Phone:281-788-6661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02165363A00000X
TX115114225XP0200X, 225XN1300X, 225XH1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman Factors
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS63811Medicare UPIN