Provider Demographics
NPI:1437302700
Name:HENRY, ELISE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-2030
Mailing Address - Country:US
Mailing Address - Phone:718-601-7400
Mailing Address - Fax:
Practice Address - Street 1:2735 HENRY HUDSON PKWY W
Practice Address - Street 2:SUITE 102
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4701
Practice Address - Country:US
Practice Address - Phone:718-601-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006762-1225X00000X
NJTR 01568225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist