Provider Demographics
NPI:1568569119
Name:ZAVODA, ELSA GABRIELLE (OT)
Entity Type:Individual
Prefix:MRS
First Name:ELSA
Middle Name:GABRIELLE
Last Name:ZAVODA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 BLUESTONE LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1333
Mailing Address - Country:US
Mailing Address - Phone:201-400-8077
Mailing Address - Fax:
Practice Address - Street 1:155 MORRIS AVE STE 2
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-1736
Practice Address - Country:US
Practice Address - Phone:973-627-0055
Practice Address - Fax:973-627-1622
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR0001000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist