Provider Demographics
NPI:1568751782
Name:PORTMAN, ELANA
Entity Type:Individual
Prefix:MRS
First Name:ELANA
Middle Name:
Last Name:PORTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ATLAS ST
Mailing Address - Street 2:UNIT #4
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5477
Mailing Address - Country:US
Mailing Address - Phone:201-874-0420
Mailing Address - Fax:
Practice Address - Street 1:106 OGLETHORPE PROFESSIONAL CT STE A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3693
Practice Address - Country:US
Practice Address - Phone:912-351-4793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP79173225X00000X, 225XP0200X
GAOT005296225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist